7 - (IOP 30) A User-centered Approach to Develop a Psychosocial Treatment for Youth with Severe Disruptive and Callous Behaviours

Introduction:
This study adopts a user-centered approach to inform the development of a tailored treatment for youth with severe disruptive and callous behaviours. Youth with disruptive and callous behaviours exhibit more severe, chronic, and violent behaviours and respond less optimally to standard treatments. Developing tailored treatments for this group is essential to reducing negative outcomes. A user-centered approach to treatment development maximizes its relevance, acceptability, and fit with the intended users and contexts.

Methods:
First, we conducted a 3-round Delphi survey with parents, clinicians, and researchers to identify treatment priority areas. A Delphi survey seeks to obtain consensus from a panel of experts. Consensus (≥75% agreement) was assessed on 42 factors across parental, emotional, cognitive, peer, and behavioural domains. In Round 1, participants (N=86; 30% parents, 36% clinicians, 33.7% researchers; 81.4% White, 76.6% female) rated the factors on importance and suggested additional factors. In Round 2, participants re-rated non-consensus items in light of group responses (medians) from the previous round. In Round 3, participants rated feasibility on consensus items. Additionally, 10 qualitative interviews were conducted to further explore past treatment experiences and perceived implementation barriers and facilitators.

Results:
Across rounds 1 and 2, 26 child factors and 30 adolescent factors met consensus criteria for importance. In round 3, participants rated feasibility of addressing these factors in treatment. Mean importance and feasibility ratings for each factor were plotted on a Go-Zone plot. The plot indicated 18 (37.5%) child factors and 22 (45.8%) adolescent factors were high on importance and feasibility. The majority of these factors relate to parenting strategies (e.g., addressing low parental warmth, negative cognitions about youth); a subset relates to emotional and cognitive deficits specific to youth with disruptive and callous behaviours (e.g., impaired perspective-taking, emotion recognition, endorsing deviant goals). Individual interviews are underway and rapid qualitative analysis will be completed by July. Themes from the interviews will further guide the design and packaging of the treatment.

Implications:
There are few tailored treatments for youth with disruptive and callous behaviours. We gathered perspectives from potential users to inform the design of a novel treatment for this population. Using a consensus approach, we identified 18 child factors and 22 adolescent factors as highly important and feasible treatment targets. These are recommended as priority areas to include in new treatment development. Cognitive-behavioural approaches are well suited to addressing these areas, such as teaching the youth emotion recognition and perspective-taking, and changing parent cognitions related to the youth. A user-centered design allows us to develop a treatment that is relevant to the current realities of youth and parents and fit with practice parameters of clinicians serving youth. Our treatment will be evaluated for efficacy in a future trial.