Attention Magazine June 2022

As ADHD experts are well awarE, SOME FAMILIES CONFRONT daily life challenges that extend well beyond the ADHD spectrum. These challenges can be of such magnitude that children who struggle with unsafe disruptive behaviors may find themselves hospitalized more than once, with some eventually referred to residential care. Worse yet, some of these families live far from any available treatment services and/or lack the financial resources to access them. It takes a special team of clinicians to work on innovative ways to address the wide-ranging needs of these children and families.

Tyler Sasser, PhD, and his colleagues at Seattle Children’s Hospital exemplify such a group of professionals. Under Dr. Sasser’s direction, they are piloting a promising online model that provides multiple hours of evidence-based treatment and support per week. The program is known as the Disruptive Behavior Intensive Outpatient Program (DB-IOP). Because its services are offered virtually, families living anywhere in the state of Washington can access the program so long as they can meet via the online platform (Zoom). The team designed the program specifically for families covered by Medicaid.

Treatment services are provided for three hours per day, three days per week (Monday, Wednesday, and Thursday). The services focus largely on supporting parents and caregivers and helping them master specific evidence-based behavior management approaches. These are approaches that have been shown to help children with significant behavioral difficulties learn to better control their behavior. By the time they are referred to DB-IOP, nearly all the families have already been through programs intended to help children manage serious behavior problems at home, with little or nothing to show for it. Clearly, says Dr. Sasser, these families need something more, something to prove to them that there’s a light at the end of the tunnel. To address this critical issue, he and his colleagues incorporated “peer partners” into their team.

Peer partners have experienced what all families in the program are now experiencing; some are still experiencing similar challenges. Peer partners show parents and caregivers currently going through the program that they’re not alone and that better days can lie ahead. They can also help them develop and sustain trust in the specific behavioral treatment practices being taught. Peer partners have developed a wellness program with a curriculum that includes topics like self-care, partnering with professionals, boundary setting, and coping with stigma. Time is set aside each Monday and Thursday for peer partners to work with parents and caregivers on this wellness curriculum.

According to Dr. Sasser, the vast majority of parents and caregivers involved in the DB-IOP are at “the end of their rope.” Their stress levels have reached a point where the parents and caregivers themselves struggle to maintain control, especially in response to aggressive or destructive behavior. Under these circumstances, he says, families need more than lessons in behavior management. So, the team builds in time on each program day to help parents and caregivers increase their own self-awareness and self-regulation in the most challenging moments.

DB-IOP focuses largely on helping parents and caregivers learn how best to help their children control and manage their behavior and their emotions. The children engage in a supervised therapeutic program with their parents one day a week (Wednesday afternoons). These services were designed to insure that the children miss very little school.

DB-IOP is six weeks in length. Team members work very closely with families during the program to find follow-up care consistent with each family’s needs. The program currently serves families of children between the ages of five and twelve. Services are supported through state funds.

Readers interested in learning more about the Disruptive Behavior Intensive Outpatient Treatment Program are encouraged to contact Dr. Tyler Sasser directly via email (tyler.sasser@seattlechildrens.org) or by telephone (206-987-2000).

A clinical and consulting psychologist, Mark Katz, PhD, is the director of Learning Development Services, an educational, psychological, and neuropsychological center in San Diego, California. As a contributing editor to Attention magazine, he writes the Promising Practices column and serves on the editorial advisory board. He is also a former member of CHADD’s professional advisory board and a recipient of the CHADD Hall of Fame Award.