These slides describe the Children of Divorce - Coping with Divorce (CoD-CoD) program as well as the clinical trial which found that it reduces mental health problems and improves coping effiacy.

1. CHILDREN OF DIVORCE-COPING WITH DIVORC
(COD-COD) :
AN INTERNET-BASED PREVENTION PROGRAM

2. ACKNOWLEDGMENTS
 I am deeply indebted to the following people for their support
of the CoD-CoD program:
 Irwin Sandler, Keith Crnic, Sandy Braver, John Horan, Jenn-
Yun Tien
 Joanne Rzucidlo, Taylor Cody, Jessica Mueller, Silvia Baez
 Joanne Pedro-Carroll, Arnold Stohlberg, Sharlene Wolchick
 Matthew Berry
 My Family
 The study was partially funded by the ASU Graduate College
Completion Fellowship.

3. WHY DEVELOP AN ONLINE PROGRAM FOR
CHILDREN OF DIVORCE?
 Children of divorce are at increased risk for a range of
poor developmental outcomes (Amato, 2001).
 Divorce is widespread
 Over 1 million children experience divorce each year (U.S.
Census, 2008).
 Children of divorce can be helped by prevention
programs targeting developing coping skills
 Children of Divorce Intervention Program
 Children’s Support Group

4. INTERNET INTERVENTIONS
 Internet-Based Program Advantages
 For Users
 Available at the time and place of the users choosing
 Availability of specialized expertise
 Reduced threat of stigma/fear of disclosure
 Instant user access
 For Researchers/Developers
 Program fidelity
 Low provision cost per user
 Ability to collect usage data
 Ability to revise instantly

5. INTERNET INTERVENTIONS
 Internet intervention programs have now been used in a
wide variety of capacities
 Depression
 Anxiety
 Eating Disorders
 Smoking Cessation
 Asthma Management
 Meta-analyses indicate potential effectiveness of internet-
based programs
 Spek et al., 2007
 Barak et al., 2008
 …and also that field has long way to go

6. THE DARK AGES PART I: THE RESEARCH
 Few trials include a randomized control group
 Many studies include inadequate measures
 Level of specificity at which the literature can inform
how to make a good program is very low.
 Bright colors

7. THE DARK AGES PART II: THE PROGRAMS
 Common problems for internet-based interventions.
 Low recruitment rates
 Mailed brochures, internet recruitment
 2.4 in 1000 (Clarke, et al., 2005)
 High Attrition
 18.6% program completion (Buller et al., 2006)
 Efficacy of reminders
 2.6 log-ins to 5.9 log-ins
 Low satisfaction
 5.9 out of 10 (Vorhees et al., 2005)
 Most programs just aren’t very cool yet.

8. COD-COD WAS DESIGNED TO BE COOL
 AFCC 3-1 (Home Practice Check-In)
 Mod1-1- (Intro Video)
 AFCC3-4 (Problems, inside tools, outside tools, actions)
**animations + adaptation/video example**
 AFCC 3-5 (Deciding if a problem is your job to fix)
**interactive activity*****
 AFCC2-25 (Choosing A Home Practice Activity)
 Video Game

9. PROGRAM DESIGN INNOVATIONS OF COD-COD
 Personal approach
 Use of humor
 Module structure designed to enhance engagement
Home Practice Review Program Goal Intro Video
Content Home Practice Assignment Quiz Video Game
 Highly interactive (activities and dynamic content)
 Creation and tracking of goal
 With contingent feedback on creating goal and progress
 Focus on in-program skills practice.
 Home Practice (with feedback on attempts)

10. CONTENT CREATION FOR COD-COD
 The skills and information taught in CoD-CoD are
based on the available evidence-based programs
for children from disrupted families.
 The Family Bereavement Project
 The Children of Divorce Intervention Program
 The Children’s Support Group
 Research on children of divorce guided the
distillation process.

11. COD-COD THEORETIC MODEL
Coping Efficacy
Active Coping
Internalizing
Symptoms
Intervention Avoidant Coping
Condition
Externalizing
Symptoms
Children’s Divorce
Appraisals

12. THEORY OF THE PROGRAM
Intervention
Modifiable
Program
Mediators
Elements
Problem-solving training
Positive cognitive restructuring
Psycho-education Active Coping
Feeling awareness
Relaxation Avoidant
Distraction coping Coping
Controllability of Stressors
Reduce wishful thinking Coping
Peer Testimonials Efficacy
Simulated Coping Practice
Positive cognitive restructuring
Divorce information Divorce
Appraisals

13. COD-COD TRIAL DESIGN
 Recruitment
 Court Records – Maricopa County
 147 children ages 11-16 randomized used block
random assignment based on risk scores.
 “Treatment As Usual” control
 Intended to approximate best case scenario in using online
resources currently available for children of divorce.

14. PARTICIPANTS
 147 children and adolescents
 78 females and 69 males
 Ages 11-16. Mean age was 13.78 (1.66).
 Divorce latency mean was 1.23 years (1.08).
 Divorce filing date, not divorce decree
 Ethnic composition includes:*
 75.2% Non-Hispanic white, 15.8% Hispanic, 3.8% Non-
Hispanic Black, 3.7%, 0.8% Native American, and 1.4%
other.
 Average years of mother's education was 14.82
(2.93). *

15. Sent Invitation Court Records Court Records
(25-45 months old) (3-16 months old)
Letters n1= 818 n = 1364
Attempted Attempted
Phone Contact Phone Contact
n= 247 n = 763
Refused/Unable to Contact Refused/Unable to Contact
n = 227 n = 652
Ineligible, n = 2 Sent Pre-Tests Sent Pre-Tests Ineligible, n = 14
n = 18 families n = 97 families
[n = 24 children] [n = 128 children]
Did Not Complete Pre- Did Not Complete Pre-
Tests Tests
n=0 n=4
[n = 0] Data Collected ¹ [n = 7]
Parent Assessment: n = 116, [n = 147]
Child Assessment: n =116, [n = 146] ² 1 One family with 2 children entered
Pre-Test the study through clinician referral.
Randomized 2 One child did not complete the
n = 112 families pre-test assessment.
[n = 147 children]
Program Condition, [n = 74]
Control Condition, [n = 73]
Program Condition Control Condition
Post-Test Provided Data Provided Data
Parent [n = 66 (89.19%)] Parent [n = 71 (97.26%)]
(1-Month) Child [n = 64 (86.49%)] Child [n = 71 (97.26%)]

16. PROCESS DATA
 89 % Home practice participation rate
 92% of completers stated that the home practice was
helpful to them.
 92% of program completers reported that they had
made progress toward the their program goal.

17. PROGRAM GOAL EXAMPLES
 To not get so angry all the time.
 I would like to understand how to better control my emotions
 For my parents to stop putting me in the middle of their problems.
 I would like to not feel so sad
 To try not to hide feelings from friends and family.

18. PROGRAM COMPLETION RATE
 Completion Rate Comparison
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Mood Gym Mood Gym BRAVE Online Project BRAVE Online Mood Gym Project CoD-CoD
2009 (a) 2009 (b) 2008 CATCH-IT 2011 2006 CATCH-IT
2008 (BA) 2008 (MI)

19. NARRATIVE FEEDBACK: CHILD
“I thought this program wasn't going to help at all but I was
wrong my parents divorce is so much easier to deal with now.
Thank you.”
11-year old girl
“CoD-CoD changed my life by making it a little easier.”
14-year old boy
“It was great. Jesse was funny.”
13-year old boy
“It taught me to control my emotions and solve difficult
problems. I can also stop myself before I say something that
will most likely hurt someone else.”
14-year old girl

20. NARRATIVE FEEDBACK: PARENT
 She is able to tell me when I am talking about something that I should only talk about with her
father. She stops me to let me know it should be between me and my ex.
-Mother of 13 year-old girl
 He has expressed on numerous occasions that he feels the program continues to help him deal
with situations that arise concerning me and his dad. Thank you for including him, I see a real
change in his coping skills. I hope that the program is able to help many others to come.
-Mother of 11-year old boy
 Recently, my son and I missed a flight at the airport. I was very frustrated with the way
the airlines handled the situation and it showed! My son, on the other hand, handled the
situation with uncommon maturity. I was very impressed when he told me that he was utilizing
some of the techniques that he had learned during your online program to manage the stress.
Great Job! Maybe I should have done the program with him.
-Father of 13-year old boy
 I watched my son a few times as he was completing his modules. He really took time and
enjoyed the videos and information provided. It has been a positive experience, and in the short
time V. participated, he has learned positive life lessons and is applying them to his daily
activities and decisions. -Mother of 15 year-old boy
 I think it made my child think a lot about ways to work though problems. She presented me with
an idea of how to resolve an argument that we had and it was a really good idea that involved
expressing feelings in a constructive manner. I was pretty impressed
-Mother of 13 year-old girl

21. MAIN EFFECTS
 Intent-to-Treat Analysis
 Reduced Total Mental Health Problems (SDQ)
 d = .37
 Reduced Emotional Problems (SDQ)
 d = .37

22. ANALYSIS OF MODERATION
 Variables examined as possible moderators
 Baseline Variable Levels
 Risk
 Age
 Gender
 Divorce Latency
 Three of the moderators examined did not significantly
moderate any program effects:
 child gender, child age, and divorce latency
 Two of moderators examined moderated program
effects on two variables:
 Baseline Variable Level
 Risk

25. GROUP X BASELINE SDQ-TOTAL

26. GROUP X BASELINE COPING EFFICACY

27. T1 Coping Efficacy x
Condition -.30*
T1 Coping .69*** T2 Coping
Efficacy Efficacy
Low T1 -.16***
Coping Efficacy
.30*
-.06
Program T2 SDQ-
Condition Total
.73***
T1 SDQ-
Total
-.15†
T1 SDQ-Total
x Condition

28. T1 Coping Efficacy x
Condition -.30*
T1 Coping .69*** T2 Coping
Efficacy Efficacy
Low T1 -.17***
Coping Efficacy
.30*
-.11*
Program T2 SDQ-
Condition Emotional
.60***
T1 SDQ-
Emotional

29. T1 Coping Efficacy x
Condition -.30*
T1 Coping .69*** T2 Coping
Efficacy Efficacy
Low T1 -.10*
Coping Efficacy
.30*
Program -.01 T2 BPI-
Condition Total
.50***
T1 BPI-
Total
-.22†
T1 Risk
-.32†
T1 Risk
x Condition

30. MAJOR FINDINGS
 The CoD-CoD program demonstrated positive effects to
reduce children’s mental health problems and to improve
coping efficacy.
 Program effects are strongest for children with greatest initial
risk/symptomatology.
 Only randomized controlled trial of an internet-based program
for children and adolescents to date to use an active control
condition.
 First experimental trial of an internet-based program for
children of divorce.
 CoD-CoD’s high program completion rate suggests that
program elements designed to increase engagement were
effective.

31. POSSIBLE USES FOR COD-COD
 Adjunct to counseling
 Stand alone universal prevention (with support).
 May be particularly appropriate with high risk children.
 The program is being made available commercially
 Starting July 2012
 Please leave me your e-mail if you’d like a program preview.
 Feel free to contact me with any questions at:
jesse.boring@familytransitions-ptw.com

32. FUTURE DIRECTIONS FOR PROGRAM REVISION
 Add a Parent Component
 Mobile Application To Support Program
 Parent and Participant Testimonials
 Weekly Chat Room / Moderated Forum
 Further Individualization
 Content (Topics, Skills, Shortening Program)
 Presentation (Videos, Videogames, Narration, etc.)
 Use Usage Data To Retool Program
 Follow-Up Modules

34. EXTRA STUFF THAT MIGHT BE HANDY
 Program Outline by Module
 Wave 1 Demographics + Pre-Test Equivalence

36. PROGRAM COMPLETION
 68.9% of CoD-CoD participants completed the entire
program.
 Average number of modules completed = 3.83.
 76.6% of the 5-module program
 84.9% of BTN participants completed the entire program.
 Average number of modules completed = 1.78.
 89.04% of the 2-module program

38. CONTROL CONDITION: SITE #1

39. CONTROL CONDITION: SITE #2