Effectiveness and Predictors of Outcomes in a Psychiatric Day Treatment Program for Elementary-Age: Children Efficacité et prédicteurs des résultats d’un programme de traitement de jour psychiatrique pour des enfants d’âge primaire

Objective: In this study, we aimed to (1) assess the effectiveness of an intensive multimodal day treatment program in improving externalizing problems and function in elementary-age children and (2) examine 3 predictors of the treatment outcome (i.e., family functioning, baseline severity, and comorbid disorders). Methods: The sample included 261 children (80.9% boys) between ages of 5 and 12. A retrospective chart review, from 2013 to 2018, and a prospective chart review, from 2018 to 2019, were conducted to extract all relevant data for the present study. Parents and teachers provided reports on children’s externalizing problems (i.e., aggressive behavior, attention problems, and rule-breaking behavior) and their level of function across different domains. The level of family functioning was also reported by parents, while clinicians assessed children’s severity of disturbance and their diagnoses at intake. Results: Based on both parents’ and teachers’ reports, children showed significant improvement in their externalizing problems. Moreover, children showed functional improvement at home, at school, with peers, and in hobbies by the end of the program. Based on teacher’s reports, children with lower level of severity showed less improvement in their attention problems, and those with comorbid developmental problems showed less improvement in their aggressive and rule-breaking behaviors. Family functioning did not predict any treatment outcome. Conclusion: An intensive multimodal day treatment program was effective in reducing the symptoms of externalizing problems in elementary-age children. However, children with less severe difficulties and comorbid developmental problems showed less improvement in their externalizing problems.

Perceived Occupational Performance in Youth with Eating Disorders: Treatment-Related Changes

Background. This study examined changes in performance and satisfaction with self-identified occupational performance goals during a specialized day treatment admission in children and adolescents with eating disorders. Weight-related outcomes for underweight youth were also examined. Methods. A total of 63 youth participated in the study, with admission and discharge data on ratings of self-identified occupational performance goals (measured with the Canadian Occupational Performance Measure) available for 42 participants. Findings. Significant improvements were found in ratings of satisfaction and performance with self-identified goals over the course of treatment. The program was also effective in supporting weight restoration for underweight youth, with a large effect size observed. Implications. A symptom-focused day treatment program for paediatric eating disorders led to improvements in perceived occupational performance. Collaborating with youth to develop self-identified goals in the context of eating disorders treatment can foster autonomy and potentially improve treatment engagement.

Behavior-Analytic Treatment Progression for a Child With Tube Dependence: Reaching Age-Typical Feeding

The current case study outlines a behavior-analytic treatment progression for a child with a pediatric feeding disorder and tube dependence. The child participated in an intensive day-treatment program for 8 weeks where she transitioned from tube feedings to oral feedings. She successfully transitioned to a less intensive, telehealth outpatient model for follow-up care where she continued to progress to age-typical feeding. Following a systematic and gradual reduction in follow-up appointments, she consumed all meals of age-appropriate foods in both home and school environments. Another important contribution of the case study is that it demonstrated the importance of follow-up services that occur in the child’s natural environment while highlighting the utility of rubrics. With rubrics, caregivers effectively and efficiently progressed toward treatment goals independently. This case study also discusses the importance of ongoing interdisciplinary collaboration and the unique contributions of each team member in employing effective interventions while ensuring client safety.