Collaborative Problem Solving (CPS)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Collaborative Problem Solving (CPS) has been rated by the CEBC in the area of: Disruptive Behavior Treatment (Child & Adolescent).

Target Population: Children and adolescents (ages 3-21) with a variety of behavioral challenges, including both externalizing (e.g., aggression, defiance, tantrums) and internalizing (e.g., implosions, shutdowns, withdrawal) who may carry a variety of related psychiatric diagnoses, and their parents/caregivers, unless not age appropriate (e.g. young adult or transition age youth)

For children/adolescents ages: 3 – 21

For parents/caregivers of children ages: 3 – 21

Brief Description

CPS is an approach to understanding and helping children with behavioral challenges who may carry a variety of psychiatric diagnoses, including oppositional defiant disorder, conduct disorder, attention-deficit/hyperactivity disorder, mood disorders, bipolar disorder, autism spectrum disorders, posttraumatic stress disorder, etc. CPS uses a structured problem solving process to help adults pursue their expectations while reducing challenging behavior and building helping relationships and thinking skills. Specifically, the CPS approach focuses on teaching the neurocognitive skills that challenging kids lack related to problem solving, flexibility, and frustration tolerance. Unlike traditional models of discipline, this approach avoids the use of power, control, and motivational procedures and instead focuses on teaching at-risk kids the skills they need to succeed. CPS provides a common philosophy, language and process with clear guideposts that can be used across settings. In addition, CPS operationalizes principles of trauma-informed care.

Program Goals:

The goals of Collaborative Problem Solving (CPS) are:

• Reduction in externalizing and internalizing behaviors

• Reduction in use of restrictive interventions (restraint, seclusion)

• Reduction in caregiver/teacher stress

• Increase in neurocognitive skills in youth and caregivers

• Increase in family involvement

• Increase in parent-child relationships

• Increase in program cost savings

Essential Components

The essential components of Collaborative Problem Solving (CPS) include:

• Three different types of intervention delivery to parents and/or children/adolescents depending on the personal situation:

o Family therapy sessions (conducted both with and without the youth) which typically take place weekly for approximately 10-12 weeks

o 4- and 8-week parent training curricula that teach the basics of the model to parents in a group format (maximum group size = 12 participants)

o Direct delivery to youth in treatment or educational settings in planned sessions or in a milieu

• In the family sessions or parent training sessions, parents receive:

o An overarching philosophy to guide the practice of the approach (“kids do well if they can”)

o A specific assessment process and measures to identify challenging behaviors, predictable precipitants, and specific thinking skill deficits. Lagging thinking skills are identified in five primary domains:

 Language and Communication Skills

 Attention and Working Memory Skills

 Emotion and Self-Regulation Skills

 Cognitive Flexibility Skills

 Social Thinking Skills

o A specific planning process that helps adults prioritize behavioral goals and decide how to respond to predictable difficulties using 3 simple options based upon the goals they are trying to pursue:

 Plan A – Imposition of adult will

 Plan B – Solve the problem collaboratively

 Plan C – Drop the expectation (for now, at least)

o A specific problem solving process (operationalizing “Plan B”) with three core ingredients that is used to collaborate with the youth to solve problems durably, pursue adult expectations, reduce challenging behaviors, teach skills, and create or restore a helping relationship.

• When directly working with the youth in treatment or education settings, providers engage youth with:

o An overarching philosophy to guide the practice of the approach (“kids do well if they can”)

o A specific problem solving process (operationalizing “Plan B”) with three core ingredients that is used to collaborate with the youth to solve problems durably, pursue adult expectations, reduce challenging behaviors, teach skills, and create or restore a helping relationship.

Child/Adolescent Services

Collaborative Problem Solving (CPS) directly provides services to children/adolescents and addresses the following:

  • A range of internalizing and externalizing behaviors, including (but not limited to) physical and verbal aggression, destruction of property, self-harm, substance abuse, tantrums, meltdowns, explosions, implosive behaviors (shutting down), crying, pouting, whining, withdrawal, defiance, and oppositionality

Parent/Caregiver Services

Collaborative Problem Solving (CPS) directly provides services to parents/caregivers and addresses the following:

  • Child with internalizing and/or externalizing behaviors, difficulty effectively problem solving with their child 
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Any caregivers, educators, and other supports are essential to the success of the approach. Caregivers, teachers and other adult supporters are taught to use the approach with the child outside the context of the clinical setting. School and clinical staff typically learn the model via single or multi-day workshops and through follow-up training and coaching.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Community Agency
  • Foster/Kinship Care
  • Hospital
  • Outpatient Clinic
  • Residential Care Facility
  • School
  • Juvenile detention/justice facility

Homework

Collaborative Problem Solving (CPS) includes a homework component:

Identifying specific precipitants, prioritizing behavioral goals, and practicing the problem solving process are expected to be completed by the caregiver and youth between sessions.

Languages

Collaborative Problem Solving (CPS) has materials available in languages other than English:

Chinese, French, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Trained personnel. If being delivered as parent group training, it requires a room big enough to hold the number of families (anywhere from a couple of parents up to 12 participants), as well as A/V equipment or printed materials for delivery of material in training curriculum.

Minimum Provider Qualifications

Service providers and supervisors must be certified in CPS. There is no minimum educational level required before certification process can begin.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Training can be obtained onsite, at Massachusetts General Hospital in Boston, at trainings hosted in other locations, online (introductory training only), or via video/phone training and coaching.

Number of days/hours:

Ranges from a 1-day introductory session to more intensive (2.5 day) advanced sessions as well as hourly coaching.

• Introductory training: These in-person and online trainings provide a general overview exposure of the model including the overarching philosophy, the assessment, planning and intervention process. Training can accommodate an unlimited number of participants.

• Two-and-a-half day intensive trainings that provide participants in-depth exposure to all aspects of the model using didactic training, video demonstration, role play and breakout group practice. Tier 1 training is limited to 150 participants. Tier 2 training is limited to 75 participants.

• Coaching sessions for up to 12 participants that provide ongoing support and troubleshooting in the model

Additional Resources:

There currently are additional qualified resources for training:

There are many certified trainers throughout North America who teach the model as well as well as systems that use the approach. The list is available at http://www.thinkkids.org/help/certified-providers-and-systems/

Implementation Information

Since Collaborative Problem Solving (CPS) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Collaborative Problem Solving (CPS) as listed below:

A CPS Organizational Readiness Assessment measure has been developed that is available for systems interested in implementing the model. It can be obtained by contacting the Director of Research and Evaluation, Dr. Alisha Pollastri, at apollastri@mgh.harvard.edu.

Formal Support for Implementation

There is formal support available for implementation of Collaborative Problem Solving (CPS) as listed below:

Think:Kids provides implementation support in the form of ongoing coaching and fidelity and outcome monitoring. There is a Director of Implementation who oversees these activities.

Fidelity Measures

There are fidelity measures for Collaborative Problem Solving (CPS) as listed below:

Site-wide Fidelity Self Study, Updated 01/2014: A guide for systems to assess the degree to which they are have put the structures in place to implement CPS with fidelity. Available to be downloaded free online at: http://www.thinkkids.org/train/materials/

CPS Treatment Integrity Manual, Rating Form, and Rating Form-Short: Fidelity tools to help measure the degree to which CPS is being practiced with fidelity in a specific encounter. Can be obtained by contacting the Director of Research and Evaluation, Dr. Alisha Pollastri, at apollastri@mgh.harvard.edu.

Implementation Guides or Manuals

There are implementation guides or manuals for Collaborative Problem Solving (CPS) as listed below:

Treatment Manual: Greene, R. W., & Ablon, J. S. (2005). Treating explosive kids: The Collaborative Problem Solving approach. New York: Guilford Press.

Clinician Session Guide: Guides the clinician in all aspects of the treatment, from initial assessment to ongoing work. Can be downloaded free online at: http://www.thinkkids.org/train/materials/

CPS Coaching Guide: A guide specifically geared towards trainer individuals who are helping caregivers to implement the model over time. Available to certified trainers.

Research on How to Implement the Program

Research has been conducted on how to implement Collaborative Problem Solving (CPS) as listed below:

Ercole‐Fricke, E., Fritz, P., Hill, L. E., & Snelders, J. (2016). Effects of a Collaborative Problem‐Solving approach on an Inpatient adolescent psychiatric unit. Journal of Child and Adolescent Psychiatric Nursing, 29(3), 127–134. doi:10.1111/jcap.12149

Pollastri, A. R., Boldt, S., Lieberman, R., & Ablon, J. S. (2016). Minimizing seclusion and restraint in youth residential and day treatment through site-wide implementation of Collaborative Problem Solving. Residential Treatment for Children & Youth, 33(3-4), 186-205.

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Greene, R. W., Ablon J. S., Monuteaux, M. C., Goring, J. C., Henin, A, Raezer-Blakely, L., Biederman, J. (2004). Effectiveness of Collaborative Problem Solving in affectively dysregulated children with oppositional defiant disorder: Initial findings. Journal of Consulting and Clinical Psychology, 72(6), 1157-1164.

Type of Study: Randomized controlled trial
Number of Participants: 47

Population:

  • Age — Children: 4-12 years; Adults: Not specified
  • Race/Ethnicity — Not Specified
  • Gender — Children: 32 Males and 15 Females; Adults: Not specified
  • Status — Participants were parents and their children with oppositional defiant disorder (ODD).

Location/Institution: Massachusetts

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the efficacy of Collaborative Problem Solving in affectively dysregulated children with oppositional defiant disorder (ODD). Participants were randomized to the parent training version of CPS or parent training (PT). Measures utilized include the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children—Epidemiologic version (K-SADS–E), the Wechsler Intelligence Scale for Children—Revised, the Parent–Child Relationship Inventory (PCRI), the Parenting Stress Index (PSI), the Oppositional Defiant Disorder Rating Scale (ODDRS), and the Clinical Global Impression–Improvement (CGI-I). Results indicated CPS produced significant improvements across multiple domains of functioning at posttreatment and at 4-month follow-up. Limitations included small sample size and length of follow-up.

Length of postintervention follow-up: 4 months.

Greene, R. W., Ablon, J. S., & Martin, A. (2006). Use of Collaborative Problem Solving to reduce seclusion and restraint in child and adolescent inpatient units. Psychiatric Services, 57(5): 610-612.

Type of Study: One group pretest-posttest study
Number of Participants: 100

Population:

  • Age — Children: 3-14 years; Adults: Not specified
  • Race/Ethnicity — Not Specified
  • Gender — Children: 74 Male and 26 Female; Adults: 24 Female and 10 Male
  • Status — Participants were children and adolescents with trauma histories and severe oppositional defiance and aggressiveness who were admitted and treated by staff at an inpatient treatment facility.

Location/Institution: Massachusetts

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the effectiveness of Collaborative Problem Solving (CPS) on staff restraint use in a sample of children and adolescents in an inpatient treatment program for severe oppositional defiance and aggressiveness. The intervention provided biweekly staff training sessions that lasted one year on restraint training using the CPS model. Surveys administered to staff during at a 15-month post-intervention follow-up showed a significant decrease in rates of restraint and seclusion and a decrease in the length of restraint procedures and injuries. Limitations include lack of randomization and lack of a control or comparison group.

Length of postintervention follow-up: 15 months.

Martin, A., Krieg, H., Esposito, F., Stubbe, D., & Cardona, L. (2008). Reduction of restraint and seclusion through Collaborative Problem Solving: A five-year, prospective inpatient study. Psychiatric Services, 59(12), 1406-1412.

Type of Study: One group pretest-posttest study
Number of Participants: 755

Population:

  • Age — Children: 10-11 years; Adults: Not specified
  • Race/Ethnicity — Children: 52% White, 25% Black, and 23% Hispanic; Adults: Not specified
  • Gender — Children: 63% Male and 37% Female; Adults: Not specified
  • Status — Participants were aggressive children and adolescents in a psychiatric inpatient hospital.

Location/Institution: Yale-New Haven Children’s Hospital

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined usage patterns of restraint and seclusion before and after the implementation of Collaborative Problem Solving (CPS) for working with aggressive children and adolescents. Measures utilized include demographic and clinical information from electronic medical records and psychiatric forms. Results indicated after implementation of the CPS model there was a reduction in the use of restraints (from 263 events to seven events per year) and seclusion (from 432 to 133 events per year). During the early phases of implementation there was a transient increase in staff injuries through patient assaults. Limitations included results do not permit a clear delineation of which exact components were active in reducing use of restraint and seclusion due to several milieu changes were instituted at the same time as part of the CPS model of care, did not include objective measures of adherence to the CPS model, and no systematic data on child injuries.

Length of postintervention follow-up: 1.5 years.

Epstein, T. & Saltzman-Benaiah, J. (2010). Parenting children with disruptive behaviors: Evaluation of a Collaborative Problem Solving pilot program. Journal of Clinical Psychology Practice, 1, 27-40.

Type of Study: One group pretest-posttest study
Number of Participants: 12

Population:

  • Age — Children: 6 -12 years, Adults: Mean=39.23 year
  • Race/Ethnicity — Not Specified
  • Gender — Children: 83% Male and 17% Female, Adults: 11 Female and 8 Male
  • Status — Participants were the parents of children with Tourette syndrome and oppositional defiant disorder who were patients at the Tourette Syndrome Neurodevelopmental Clinic (TSNC).

Location/Institution: Toronto, Ontario, Canada

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the effectiveness of Collaborative Problem Solving (CPS) in families with children with Tourette syndrome and oppositional defiant disorder. Parents completed the Eyberg Child Behavior Inventory (ECBI), Social Competence Scale, and the Parenting Stress Index-Short Form (PSI-SF) at four time points: baseline, pre-intervention, post-intervention, and at 2-month follow-up. Program staff administered the Oppositional Defiant Disorder Rating Scale and the Clinical Global Impression Scale during parent phone interviews at four time points. Two separate treatment groups were completed approximately one year apart. Results indicated that a significant reduction in parenting stress occurred for mothers as a result of the intervention and parents reported increased empathy for child problem behaviors. Limitations included small sample size, lack of randomization, and lack of a no-treatment control or comparison group.

Length of postintervention follow-up: 2 months.

Schaubman, A., Stetson, E., & Plog, A. (2011). Reducing teacher stress by implementing collaborative problem solving in a school setting. School Social Work Journal, 35(2), 72-93.

Type of Study: One group pretest-posttest study
Number of Participants: 16

Population:

  • Age — Not Specified
  • Race/Ethnicity — Not Specified
  • Gender — Not Specified
  • Status — Participants were teachers and their special education students.

Location/Institution: Colorado

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to determine the efficacy of Collaborative Problem Solving (CPS) to reduce teacher stress. Measures utilized include the Index of Teaching Stress (ITS), and the Thinking Skills Inventory. Results showed a significant decrease in teacher stress and student misbehavior. Further, discipline referrals were significantly reduced. Limitations include small sample size, lack of randomization of participants, lack of control group, and lack of follow-up.

Length of postintervention follow-up: None.

Johnson, M., Östlund, S., Fransson, G., Landgren, M., Nasic, S., Kadesjö, B., Fernell, E. (2012). Attention-deficit/hyperactivity disorder with oppositional defiant disorder in Swedish children – an open study of collaborative problem solving. Acta Paediatrica, 101(6), 624-630.

Type of Study: One group pretest-posttest study
Number of Participants: 17

Population:

  • Age — Children: 6-13 years (Mean=9.2 years); Parents: Not specified
  • Race/Ethnicity — Children: 100% Swedish; Parents: Not specified
  • Gender — Children: 12 Males and 5 Females; Parents: Not specified
  • Status — Participants were parents and their children diagnosed with attention-deficit/hyperactivity disorder (ADHD) with oppositional defiant disorder (ODD) in an outpatient setting.

Location/Institution: Sweden

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to evaluate Collaborative Problem Solving (CPS) in children with attention-deficit ⁄hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). Measures utilized include the Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IV), the Swanson, Nolan and Pelham (SNAP-IV) Questionnaire, the Clinical Global Impression-Improvement (CGI-I), the Conners' 10-item scale and the Family Burden of Illness Module (FBIM). Results indicate that all participants had significant reductions in SNAP-IV ODD, ADHD, and total Conners' and FBIM scores, both at postintervention and at 6-month follow-up. Eight of the children, although significantly improved on ODD scores and the Conners' emotional liability subscale at post-intervention, had almost no improvement in hyperactivity/impulsivity. Limitations include small sample size, lack of randomization, and lack of control group.

Length of postintervention follow-up: 6 months.

Stetson, E., & Plog, A. (2016). Collaborative Problem Solving in schools: Results of a year-long consultation project. School Social Work Journal, 40(2),17-36.

Type of Study: One group pretest-posttest study
Number of Participants: 49

Population:

  • Age — Children: 5-16 years; Adults: Not specified
  • Race/Ethnicity — Children: 78.1% White, 12.5% African American, 3.1% Hispanic, and 6.2% Other; Adults: Not specified
  • Gender — Children: 90.6% Male, and 9.4% Female; Adults; Not specified
  • Status — Participants were teachers and their special education students.

Location/Institution: Colorado

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to determine the efficacy of Collaborative Problem Solving (CPS) to reduce teacher stress. Measures utilized include the Parenting Stress Index-Short Form (PSI-SF), the Index of Teacher Stress (ITS), the Social Skills Improvement System Rating Scales (SSIS), and the Behavior Rating Inventory of Executive Function (BRIEF). Results show that teachers who learned CPS reported significantly reduced levels of stress when working with challenging students. Further, both parent and student reports indicated a reduction in problem behaviors. Results also indicate that students built skills in the areas of behavior regulation and emotional control. Limitations include small sample size, lack of randomization of participants, lack of control group, and lack of follow-up.

Length of postintervention follow-up: None.

Pollastri, A. R., Boldt, S., Lieberman, R., & Ablon, J. S. (2016). Minimizing seclusion and restraint in youth residential and day treatment through site-wide implementation of Collaborative Problem Solving. Residential Treatment for Children & Youth, 33(3-4), 186-205.

Type of Study: Two group pretest-posttest study
Number of Participants: Not specified

Population:

  • Age — Not Specified
  • Race/Ethnicity — Not Specified
  • Gender — Not Specified
  • Status — Participants were in residential and day treatment and included youth in foster care and child welfare.

Location/Institution: Oregon

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This purpose of this study was to describe the results of one agency’s experience implementing the approach organization-wide and its effect on reducing seclusion and restraint (S/R) rates. It describes significant decreases in the rates of restrictive practices used and improvements in youth outcomes during that time. The study (1) briefly describes the Collaborative Problem Solving (CPS) approach, (2) describes agency-¬‐wide implementation of CPS and the challenges this agency faced, (3) reports rates of S/R across two programs in which data are available before and after adoption of CPS, and (4) presents an exploratory analysis of improved youth outcomes that may support LeBel and Goldstein’s assertion that reducing S/R contributes to improved outcomes through redistribution of staff time into therapeutic activities. Measures utilized include the Child and Adolescent Functional Assessment Scale (CAFAS) and the Child and Adolescent Needs Assessment (CANS). Results indicate that during the time studied, frequency of restrictive events in the residential facility decreased from an average of 25.5 per week to 2.5 per week, and restrictive events in the day treatment facility decreased from an average of 2.8 per week to 7 per year. An estimate of the five-year cost savings at the residential facility studied would be $176,750 and the four-year cost savings at the day treatment program would be $162,953. This combined $339,703 in savings would be for restraint reduction alone. Limitations include lack of randomization of participants, lack of control group, and lack of follow-up.

Length of postintervention follow-up: None.

References

Greene, R. W., & Ablon, J. S. (2005). Treating explosive kids: The Collaborative Problem Solving approach. New York: Guilford Press.

Greene, R. W., Ablon, J. S., Goring, J. C., Fazio, V., & Morse, L. R. (2003). Treatment of oppositional defiant disorder in children and adolescents. In P. Barrett & T.H. Ollendick (Eds.), Handbook of Interventions that work with children and adolescents: Prevention and treatment. West Sussex, England: John Wiley & Sons.

Pollastri, A. R., Epstein, L. D., Heath, G. H., & Ablon, J. S. (2013). The Collaborative Problem Solving approach: Outcomes across settings. Harvard Review of Psychiatry, 21(4), 188-199.

Contact Information

Name: J. Stuart Ablon
Title: Director
Agency/Affiliation: Think:Kids at Massachusetts General Hospital
Website: www.thinkkids.org
Email:
Phone: (617) 643-6024
Fax: (617) 643-9715