Family Telemental Health Intervention for Veterans With Dementia
Phase: NA
Conditions: Dementia Family Caregiver Burden and Conflict
Sponsor: VA Office of Research and Development

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Title: Family Telemental Health Intervention for People with Dementia and their 
Caregivers 
Protocol # 1567 
Principle Investigator: Cory K. Chen, PhD 
Co-Investigators: Scott Sherman, MD; Joshua Chodosh, MD 
Abstract: 
The increase in prevalence of dementia over the last 50 years has resulted in a concomitant 
rise in the number of families facing the physical, emotional, and psychological stress associated 
with caregiving. Behavioral symptoms that occur in persons with dementia (PWD) lead to 
negative mental and physical health outcomes for caregivers and predict caregiver decisions to 
institutionalize PWD.  Resources to Enhance Alzheimer’s Caregiver Health - VA (REACH VA), 
has demonstrated its ability to improve caregiver burden, emotional and physical well-being, 
social support and management of behavioral symptoms. Although REACH VA represents one 
of the best available approaches to help caregivers, treatment non-response and modest treatment 
effects remain significant issues. A variety of factors may be associated with non-response to 
behavioral intervention — one particularly robust predictor of non-response is interpersonal skill.  
The goal of this research project is the first step toward systematically identifying and 
addressing caregiver interpersonal challenges using telehealth technology. Observation via 
telehealth provides the physical and emotional distance for better identification of interpersonal 
behaviors that may be more difficult to achieve when in person in addition to providing the 
opportunity for recording interactions. This project involves three interrelated activities: (1) 
refinement and pilot testing of a video based observational coding manual (OCM) to evaluate  
interpersonal skills of family caregivers interacting with PWD (2) development of a treatment 
manual integrally linked to the OCM and (3) assessment of the feasibility of delivering the 
treatment. 
Methods: 
Participants: We anticipate that approximately a total of 20 caregivers will be recruited into the 
study. No participants will be excluded because of gender, race, health status, or marital status.  
Although care recipients will have dementia, for those with mild to moderate dementia, 
evidence from prior studies demonstrate that such individuals often have decision-making 
capacity and are able to recognize the risk-benefit profiles of various research study scenarios. 
Care-recipients who refuse to participate in the study will not be approached again.  
We will use the standard procedures for addressing capacity that are employed by many 
institutions’ human subjects review boards. The following questions will be employed:  
I just went over what participating in this study entails. I am going to ask you a few 
questions just to make sure you understand the study before we begin.  

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1. What would you be doing if you agree to participate in this study?  
(Examples of acceptable answers: “Answer questions,” or “Talk to my family member.”)  
☐ Person is able to answer this ☐ Person is not able to answer this  
2. What can you do or ask me to do if you are uncomfortable with a particular question?  
(Examples of acceptable answers: “Ask to skip the question.” “Ask you to ask something 
else.”)  
☐ Person is able to answer this ☐ Person is not able to answer this  
3. What can you do if you decide after we start that you do not want to participate in the 
study?  
(Examples of acceptable answers: “Tell you that I do not want to do this anymore.”)  
☐ Person is able to answer this ☐ Person is not able to answer this 
 
Eligibility: Either the caregiver or the care-recipient must be a Veteran.  
The caregiver must: 
1. Be at least 18 years old 
2. Be the primary family or friend who helps or supports an individual with dementia 
3. Be involved in the care of the person with dementia (at least 4 hours of care per day). 
4. Report that the care-recipient exhibits behavioral problems that are distressing. 
5. Not be currently receiving the REACH VA protocol. 
Additionally, the care-recipient must: 
1. Must have a documented diagnosis of dementia 
2. Have cognitive impairment (MMSE<23 or SLUMS<20 or diagnosis of dementia based 
on chart review) 
3. Be out of bed and able to respond to a caregiver’s instructions or interventions 
Although we will accept caregivers without significant mood symptoms or burden into 
the pilot, we will strive for a minimum of 50% of the sample with either PHQ-9>5 or Zarit 
Burden Scale >9 to ensure sufficient data on distressed caregivers. 
Should worrisome conditions such as depression, suicidality, or other concerning clinical 
conditions be apparent during a research interview or observation, treatment interviewers and 
therapists will follow a scripted protocol to notify the appropriate medical personnel and the PI 
so that appropriate notification and clinical follow-up is ensured. All research staff will also be 
trained to provide appropriate referrals to non-VA resources for caregivers who experience 
distressing symptoms during the study, as caregivers may be ineligible for VA care.  
Recruitment: We will utilize a multimodal recruitment approach consisting of: targeted direct 
mail, provider referral, and advertisements. Subject recruitment will occur via referral from VA 
providers in Primary Care, the Geriatric Clinic, Family Caregiver Program, Memory Disorders 

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Clinic, Neuropsychological Testing Service, Home Based Primary Care, Psychology Service, 
and the Social Work Service of the three campuses participating in the study. We will meet with 
key providers caring for large numbers of Veterans with dementia, provide study details, and 
weekly follow up until recruitment numbers are achieved. All providers will have easy access to 
handouts describing the project to facilitate provider-patient discussions about possible referral. 
Additionally, to recruit Veterans who serve as caregivers to family or friends we will advertise: 
(1) in Primary Care and Mental Health Clinics on all three campuses of VA NYHHCS, (2) on 
websites (e.g. the Alzheimer’s Association, NY State Division of Veteran’s Affairs, social 
networking sites), (3) with community organizations who serve Veterans (e.g. Vietnam Veterans 
of America -NY Chapter).  
Procedure: This project involves two interrelated activities: (1) refinement and pilot testing of a 
video based observational coding manual (OCM) to evaluate the interpersonal skills of family 
caregivers interacting with PWD, (2) development and pilot testing of a treatment manual 
integrally linked to the OCM that is designed to improve caregiver interpersonal skills. 
 (1) Refining and pilot testing the OCM: We will convene an Expert Advisory Panel (EAP) with 
expertise in interpersonal and family caregiving processes and family psychotherapy to provide 
feedback on the OCM. The OCM represents an adaptation of previously established and reliable 
coding manuals developed for assessing interaction patterns in couples, families, and dementia 
caregiver research. Using an iterative process of refinement based on EAP feedback, pilot coding 
of video from five initial dyads, and feedback from those dyads we will use coding schemes 
originally developed for research and adapt them for clinical use. We will then recruit 15 
additional dyads and videotape their interactions. Five Psychology Trainees will be trained on 
the OCM. The PI and pairs of Psychology Trainees will independently code each video to assess 
validity (face, concurrent, convergent, discriminant, content, and criterion), reliability (alternate 
form, inter-rater, and internal consistency) and analyze qualitative data from semi-structured 
interviews of caregivers, care-recipients, and clinicians to assess acceptability and utility of the 
OCM.  
(2) Development and pilot testing of the Family Intervention: As the OCM is being created, we 
will draft a treatment manual for a family intervention informed by established empirically 
supported interventions for couples and families. The treatment manual will specifically target 
the identified interpersonal skills deficits in the OCM. A draft of the Treatment Manual will be 
presented to the EAP, eliciting feedback for further refinement. We will pilot test the family 
intervention via telehealth with the dyads who received the OCM and assess feasibility of 
delivery, dyad benefit from dyad and therapist report, and descriptive analyses of changes in 
interpersonal conflict, caregiver depression, anxiety, and burden.  
Study Visits and Measures: 

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Visits: 
Dyads will be recruited in 2 waves. 
In wave 1, 5 dyads (or more dyads until sufficient data is collected for the development of the 
intervention, estimated 5-10 dyads total) will be recruited and complete 
1. First Contact,  
2. Assessment Session 
3. Recording Task 
4. Feedback session, Caregiver Intervention is Offered  
In wave 2, the remaining dyads will be recruited and complete 
1. First Contact,  
1a. Assessment Session,  
2. Recording Task,  
3. Family Therapy, and 
3a. Exit Measures. 
3b.Therapist Exit Measures (Participants will not be present for this) 
 
1. First Contact (15 minutes, wave 1 only): Initial contact with the caregiver will consist of brief 
contact to both share information about the study with the caregiver, as well as get basic 
screening information from the caregiver. Caregiver will be asked their care recipient’s 
current diagnosis and whether the care recipient is currently bed bound, this information will 
be used as screening for inclusion/exclusion criteria only in order to reduce participant 
burden of travel to the VA for screening visits, and will not be stored as research data. At this 
time, the participant dyads will also be screened for potential participation in another 
caregiver intervention that focuses on dementia caregiver support (including but not limited 
to the Dementia Caregiver Intervention) which will be offered in lieu of the Family Therapy 
intervention that is only offered for wave 2 participants. The Assessment Session will be 
scheduled. This screening can be completed via phone or in person, based on the patient’s 
preference. 
 
2. First Contact (15 minutes, wave 2): Initial contact with the caregiver will consist of brief 
contact to both share information about the study with the caregiver, as well as get basic 
screening information from the caregiver. Caregiver will be asked their care recipient’s 
current diagnosis and whether the care recipient is currently bed bound, this information will 
be used as screening for inclusion/exclusion criteria only in order to reduce participant 
burden of travel to the VA for screening visits, and will not be stored as research data. At this 
time, the Assessment Session will be scheduled. This screening can be completed via phone 
or in person, based on the patient’s preference. 
 
1a. Assessment Session (2 hours, Waves 1 & 2): The Assessment Session will be done in person 
with study staff. All participants (care recipient and care giver) will sign required study 
informed consent documents prior to the collection of any data. Participants found to be 

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eligible will proceed with the Telehealth Assessment, participants found ineligible will not be 
enrolled in the Telehealth Assessment or Family Treatment. Additional VA and community 
resources will be offered. Eligibility will be determined based on the administration of the 
following items:   
a. Demographics 
b. HABC Monitor 
c. KCMS 
d. PHQ-9 
e. GAD-7 
f. Zarit 
 
3. Recording Task (1 hour, all waves): We will use existing telehealth facilities and equipment 
to record dyads as they engage in the two OCM tasks. Research staff will bring participants 
to designated telehealth rooms and ensure the equipment is operating appropriately. They 
will then leave the room and a research staff will present the rationale and instruction for 
each task via the telehealth video monitors. The first task will be recorded for 10 minutes. 
After 10 minutes, research staff will provide instructions for a second 10-minute task via the 
telehealth video monitors. The second task will be recorded for 10 minutes.  
a. Task 1: Dyads will collaboratively plan a hypothetical pleasant event. This task will 
allow clinicians to observe the caregiver’s ability to involve the care-recipient in 
eliciting preferences, validating feelings and desires, demonstrating emotional 
engagement and connection, and providing appropriate structure and guidance around 
planning this hypothetical event.  
b. Task 2: Dyads will work together to complete a puzzle. We will instruct caregivers to 
not solve the puzzle themselves but to assist care-recipients in the completion of the 
task. The task will allow clinicians to observe the caregiver’s ability to reduce 
complex tasks into simple instructions, observe and modify the approach based on 
care-recipient reactions, regulate care-recipient frustration, and simultaneously attend 
to the care-recipient’s feelings and the successful completion of the task. 
 
2a. Feedback Session (30 minutes, Wave 1 only), Research staff will conduct semi-structured 
interviews separately with each member of the dyad to assess reactions to participating in the 
tasks, perceived benefit, ways to make the tasks more relevant, and willingness to participate 
in additional treatment following the tasks. Research staff will tailor the care-recipient 
interview to fit care-recipients’ needs and verbal abilities. 
 
4. The Dementia Caregiver Intervention (~4-6 weeks, Wave 1 only) The intervention offers 
short-term therapy for caregivers of persons with dementia to assist in communication, 
problem-solving, and caregiver stress management. Some Dementia Caregiver Intervention 
intake measures overlap with the current study’s intake battery, including the demographics 
forms, PHQ-9, GAD-7, and Zarit Burden Scale. Based on the First Contact eligibility results, 
the participant will be offered the opportunity to enroll and participate in both the current 
study and a separate caregiver intervention. Once consented, the participants will complete 
the additional caregiver intervention specified intake measures (the Adult Attachment Scale, 

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URICA Readiness for Mental Health Treatment, Dementia Severity Rating Scale, the 
Multidimensional Scale of Perceived Social Support, the Structured Clinical Interview for 
DSM-IV Axis II Personality Disorders, the Personality Assessment Inventory, and the Secure 
Base Script Assessment – Older Adult Version) in addition to the current study measures. 
This will only be offered to the first five participant dyads to enroll in the current study. 
Participants have the option to come in on a separate day to consent to and complete 
measures for the Dementia Caregiver Intervention.  
 
5. Family Therapy (~12-16 weeks, Wave 2 only): Performed by Family Therapist Dr. Cory 
Chen. Our development of the treatment manual will be informed by the specific 
interpersonal skills deficits identified in the process of refining the OCM. We anticipate that 
the treatment manual will be approximately 12-16 sessions and will include the following 
specific strategies, the implementation of which will be tailored by clinicians to the specific 
interpersonal deficits identified in the OCM: (1) psychoeducation on dementia, (2) 
communication and problem solving skills, (3) safety building skills, (4) relationship 
satisfaction enhancement skills, (5) “meaning making” (i.e. collaboratively identifying the 
personal significance of events), (6) identification of core patterns from dyad relationship 
history, (7) techniques to shift emotional responses, (8) techniques to increase emotional 
attunement, and (9) techniques to increase attunement to care-recipient needs 
 
3a. Exit Measures (2 hours, Wave 2 only): The Exit Measures will be done in person with study 
staff. Tasks will include 
a. KCMS 
b. PHQ-9 
c. GAD-7 
d. Zarit 
e. Semi-Structured Interview (Separate for Caregiver and Care Recipient, when 
possible) 
 
3b. Therapist Exit Measures (30 minutes, Wave 2 only; Participant not present): Research staff 
will conduct semi-structured interviews with Family Therapist to gather data on their experience 
providing the treatment and potential modifications to both the treatment and the OCM based on 
therapist experience providing the family intervention. 
 
Measures: 
1. Healthy Aging Brain Center Monitor (HABC Monitor): A 31-item caregiver assessment of 
dementia severity, caregiver stress, and mood. Contains three patient symptom domains 
(Cognitive, functional, behavioral/psychological) and a caregiver quality of life domain. 
Shown to have good internal consistency (0.73-0.92) and construct validity. 
2. The Kansas Marital Conflict Scale (KMCS): A 37-item self-report scale consisting of three 
subscales of how well partners are able to: (1) listen and understand each other’s 

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perspectives, (2) express his or her point of view , and (3) come to a mutually satisfactory 
compromise. It has been shown to have high internal consistency (α = .87 to .90) and test-
retest reliability (r = .62 to .92). Although developed for marital relationships, all items are 
applicable or easily modified for a variety of interpersonal relationships.  
3. Patient Health Questionnaire – 9 (PHQ): A 9-item self-report scale based on DSM-IV criteria 
for Major Depressive Disorder, has been shown to have good sensitivity and specificity and 
is predictive of health outcomes such as sick days, clinic visits, and symptom related 
difficulty. Internal reliability of the PHQ-9 is excellent (α = 0.89).  
4. Generalized Anxiety Disorder Screener (GAD-7): A 7-item self-report scale used to assess 
anxiety symptoms. It has demonstrated good reliability, sensitivity (0.89) and specificity 
(0.82). Originally designed to assess Generalized Anxiety Disorder, it has been used as a 
screening and symptoms severity measure for a range of common anxiety disorders.  
5. Zarit Burden Scale: A 12-item self-report scale shown to have acceptable indices of internal 
consistency for the two distinct factors of the scale – personal strain and role strain (α =0.88 
and α =0.78) and a good predictor of caregiver mental health outcomes. 
6. Feedback Session Interview: We will conduct semi-structured interviews with the initial five 
dyads following the two interaction tasks of OCM V-2 for additional refinement in 
developing OCM V-3. Research staff will conduct semi-structured interviews separately with 
each member of the dyad to assess reactions to participating in the tasks, perceived benefit, 
ways to make the tasks more relevant, and willingness to participate in additional treatment 
following the tasks. Research staff will tailor the care-recipient interview to fit care-
recipients’ needs and verbal abilities. We will incorporate dyad feedback into OCM V-3. 
7. Exit Measures Semi-Structured Interview: Similar to the Feedback Session Interview, yet 
modified for based on information gathered from that interview. This will be given to the 15 
dyads in Wave 2. 
8. Therapist Exit Measures: Research staff will conduct semi-structured interviews with Family 
Therapist to gather data on their experience providing the treatment and potential 
modifications to both the treatment and the OCM based on therapist experience providing the 
family intervention. 
 
OCM Development: 
 
OCM Versions: OCM Version-1 (V-1) is adapted from established and reliable coding manuals 
designed to assess interaction patterns in couples, families, and dementia caregiver research. We 
will create OCM V-2 based on EAP guidance and feedback. OCM V-3 will be created based on 
pilot testing on 5 dyads and dyad feedback. OCM V-4 will be developed based on a second 
round of EAP feedback. We will use OMC V-4 to train interventionists, who will pilot test it 
with 15 dyads for reliability, validity, and utility. 

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Expert Advisory Panel: We will use two rounds of feedback from an Expert Advisory Panel 
(EAP) with expertise in family caregiving processes and two rounds of pilot testing with dyads 
to refine and test the OCM. EAP members will not be exposed to PHI. 
Expert Advisory 
Panel Members  
Institution 
Expertise  
Steffany Fredman, 
PhD  
Penn State 
University, Dept. of 
Human Dev. and 
Family Studies  
Co-Creator of Cognitive Behavioral Conjoint 
Therapy for PTSD and developer of 
observational coding protocol for family 
emotional involvement  
David Miklowitz, 
PhD  
University of 
California – Los 
Angeles, Semel 
Institute  
Creator of Family Focused Therapy for Bipolar 
Disorder and expert in family observational 
coding  
Zoya 
Simakhodskaya, 
PhD  
New York University, 
New York Center for 
Emotionally Focused 
Therapy  
Expert in Emotion Focused Therapy for couples  
Theodore Waters, 
PhD  
New York University, 
Dept. of Psychology  
Expert in coding of attachment processes in 
family and couples interactions.  
Sarah Yarry, PhD  
VA New York 
Harbor Healthcare 
System  
Co-Creator of ANSWERS Family Intervention 
for Caregivers of Individuals with Dementia  
Steven Zarit, PhD  
Penn State 
University, Dept. of 
Human Dev. and 
Family Studies  
Expert in Dementia Caregiving  
 
Treatment: 
Based on Stage I treatment manual development guidelines, an outline of the treatment 
and description of the major contents of sessions  will be developed and include: (1) overview, 
description, and rationale, (2) formulation of the problem, (3) treatment goals, (4) similarities 
and distinctions from other approaches, (5) specifications of defining interventions (unique and 
not unique essential elements, recommended elements, proscribed elements), (6) session content, 

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and (7) description of format for delivery. Treatment will be adapted from empirically supported 
family and couples protocols designed in other contexts where significant caregiving is provided 
to an identified patient (i.e. when one member of the couple or family has a physical or mental 
illness or in the context of parenting skills training).  
Our development of the treatment manual will also be informed by the specific 
interpersonal skills deficits identified in the process of refining the OCM. We anticipate that the 
treatment manual will be approximately 12-16 sessions and will include the following specific 
strategies, the implementation of which will be tailored by clinicians to the specific interpersonal 
deficits identified in the OCM: (1) psychoeducation on dementia, (2) communication and 
problem solving skills, (3) safety building skills, (4) relationship satisfaction enhancement skills, 
(5) “meaning making” (i.e. collaboratively identifying the personal significance of events), (6) 
identification of core patterns from dyad relationship history, (7) techniques to shift emotional 
responses, (8) techniques to increase emotional attunement, and (9) techniques to increase 
attunement to care-recipient needs.  
A draft of the Treatment Manual will be presented to the EAP with a series of questions 
to obtain feedback and identify additional modifications necessary for successful implementation 
given the unique characteristics of: 1) clinicians in the VA providing treatment and 2) VHA 
medical centers where the treatment will be delivered. The draft will be sent to the EAP for 
feedback at month 5 (with OCM V-3). EAP members will provide written feedback on the 
treatment manual with proposed modifications. The PI will use panel feedback to revise the 
treatment manual. A summary of the EAP feedback will be created and sent to EAP members 
with the revised treatment manual. EAP members will review other EAP members’ feedback, 
their own prior ratings, and the revised treatment manual. We will convene the EAP over 
telephone or CVT to discuss the new draft of the treatment manual and obtain additional 
feedback to complete the final version of the treatment manual.    
 
Training: 
 
Psychology Trainees will be participants in the VA NYHHS Externship Program. 
Training will include presentation of literature on dementia, caregiving, and other topics relevant 
to the OCM. Examples of prototypical interactions will be shown to illustrate behavioral anchors 
for scoring. The infrastructure for the psychology training program has been in operation for the 
last four and a half years. We will train psychology trainees on the OCM V-4 including a 2-hour 
didactic and practice/explanation of coding procedures illustrated by video recorded interactions 
of the five dyads used to Pilot Test OCM V-2.  
 
Following completion of training, psychology trainees will watch the dyad interaction 
videos of the 15 dyad pairs and code the interactions based on the procedure learned in OCM V-
4 training. Two psychology trainees will watch and code each video to evaluate interrater 
reliability. The PI will also rate each video as a criterion coder. Research staff will conduct semi-

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structured interviews with psychology trainees to gather data on their experience learning the 
coding, coding the interactions, and perception of the clinical utility of the coding procedure. 
 
Data Analysis: 
Assessment of Validity of OCM V-4 
1. Face Validity will be established based on interpretation of qualitative interview data of 
caregiver, care-recipient, OCM rater, and EAP panel member responses regarding the 
relevance of the tasks and coding method. We will use Grounded Theory, a systematic and 
rigorous set of principles for text interpretation developed by Strauss and Corbin (1998) to 
interpret qualitative data. During an “open coding” phase, meaningful statements that convey 
discrete concepts and ideas will be identified and allocated a code that maintains the meaning 
of the original expression as closely as possible. The constant comparative method of 
analysis will be used to continually refine the interview and coding procedure. This method 
involves an iterative process of making comparisons at each level of analysis (data with data, 
data with codes, codes with categories, etc.) throughout data collection and analysis. This 
process allows investigators to continuously modify and refine coding and create categories 
as data is being collected and analyzed. After the initial round of coding, all interviews will 
be recoded to ensure that the final codes are applied equally to all interviews. The codes will 
be grouped together into higher-level categories and ultimately distilled into the main themes 
of the research. Over the course of the process, a record of the process of idea generation, 
analyses, questions and hypothesized theoretical understandings will be maintained. Our 
initial hypothesized understanding is based on literature from CBT couples and family 
therapy, Expressed Emotion, Emotion Focused Therapy, and Attachment Theory ,  
2. Concurrent Validity will be established by examining the correlation between the OCM V-4 
summary scores and the Kansas Marital Conflict Scale (KMCS), a self-report measure 
designed to assess interpersonal difficulties. Due to the small sample size, we will use 
Spearman’s correlation coefficient. We anticipate OCM V-4 scores to be moderately to 
highly correlated with the KMCS.  
3. Convergent Validity will be established by examining the correlation between the OCM V-4 
summary scores and constructs that are anticipated to be different but related to interpersonal 
difficulties. We anticipate OCM V-4 scores to be moderately correlated with HABC Monitor 
behavioral/psychological and caregiver quality of life subscales, Zarit Burden, PHQ-9 rated 
depression, and GAD-7 rated anxiety.  
4. Discriminant Validity will be established by examining the correlation between the OCM V-
4 summary score and variables anticipated to be unrelated or less related to interpersonal 
difficulties (e.g. HABC Monitor cognitive and functional subscales, education, SES, 
religion). We anticipate OCM V-4 scores to show no or small correlations with these 
variables. We will also compare the mean OCM V-4 summary scores of caregivers who 
experience significant caregiver burden or depression (PHQ-9>5 or Zarit Burden Scale >9) to 
those who do not report significant burden and depression to determine whether the 

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identified interpersonal variables differentiate caregivers who are experiencing significant 
distress from those who are not.  
5. Criterion Validity will be established by examining inter-rater reliability of the trainee’s 
coding with those of the PI as the Criterion Coder. We anticipate that the trainees will show 
good reliability with the Criterion Coder.  
6. Content Validity will be established by calculating a content validity ratio to analyze the 
EAP’s evaluation of each item in the OCM as “essential,” “useful, but not essential,” or “not 
necessary.” 
 
Dyad Perceived Feasibility and Utility of Treatment: Following treatment, research staff will 
assess caregivers with the KMCS, PHQ-9, GAD-7, Zarit burden scales and conduct semi-
structured interviews with caregivers (and care-recipients, when possible) to assess reactions to 
the treatment, perceived benefit, feedback how to make the treatment more relevant, and 
willingness to refer others to the treatment. We will summarize retention rates and conduct 
descriptive analyses of the primary outcomes (mean with SD, median with IQR, boxplot, and 
frequency table) at baseline and post treatment. Within group effect sizes (Cohen’s d) will be 
calculated. The constant comparative method of analysis will be used to analyze qualitative 
interview data. 
 
Clinician Perceived Feasibility and Utility of Treatment: Research staff will conduct semi-
structured interviews with family therapists to gather data on their experience providing the 
treatment and potential modifications to both the treatment and the OCM based on therapist 
experience providing the family intervention. Research staff will record and transcribe all 
interviews for qualitative analysis. The constant comparative method of analysis will be used to 
analyze qualitative interview data.