Intervention Summary

Children of Divorce Intervention Program (CODIP)

The Children of Divorce Intervention Program (CODIP) is a school-based preventive intervention delivered to groups of children ages 5-14 who are dealing with the challenges of parental separation and divorce. CODIP offers four versions that are developmentally tailored for specific age groups (kindergarten and grade 1, grades 2 and 3, grades 4-6, and grades 7 and 8). The intervention is designed to modify children's risk and protective factors, including emotion regulation, problem-solving skills, understanding of family changes, anxiety, internalizing problems, and stress-related physical symptoms.

Grounded in cognitive behavioral therapy and child developmental theory, the program focuses on three major substantive themes: children's divorce-related feelings, effective coping skills, and emotion regulation. These themes are addressed during 12-15 play-based sessions lasting 40-60 minutes each, depending on the age of the students. The first set of sessions addresses children's divorce-related feelings and understanding of family changes, providing children with an opportunity to get to know one another and share their feelings and common experiences. These sessions also focus on clarifying children's misconceptions about divorce, and books and film are used interactively to convey an understanding of family transitions. In the second set of sessions, children are taught self-statements and techniques for resolving interpersonal problems. A key distinction is made between problems beyond the children's control (e.g., parent reconciliation) and those within their control (e.g., appropriate ways of communicating their feelings). In the last set of sessions, anger and other common divorce-related feelings are addressed using puppet play for young children and role-play for older children. Common divorce-related problems are acted out with real-life examples of effective ways of solving problems. The final session focuses on evaluating the group experience and discussing feelings around completion of the program. The sessions employ interactive games, role-play, skits, and group discussions to facilitate the expression of feelings and reinforce the lessons learned. Sessions are cofacilitated by CODIP-trained group leaders who are mental health professionals (e.g., school psychologists, social workers, counselors) or paraprofessionals supervised by a mental health professional. The intervention has been used in community centers and health care provider offices in addition to schools.

The studies reviewed for this summary used the CODIP versions for kindergarten and grade 1, grades 2 and 3, and grades 4-6. The mean number of years since the parents' separation/divorce varied by study but ranged from approximately 2 to 4 years.

Descriptive Information

Areas of Interest	Mental health promotion
Outcomes	1: School-related behaviors and competencies 2: Behavioral and emotional adjustment to divorce 3: Anxiety 4: Attitudes and feelings about family
Outcome Categories	Family/relationships Mental health Social functioning
Ages	6-12 (Childhood)
Genders	Male Female
Races/Ethnicities	American Indian or Alaska Native Asian Black or African American Hispanic or Latino White Race/ethnicity unspecified
Settings	School
Geographic Locations	Urban Suburban Rural and/or frontier
Implementation History	CODIP was first implemented in five suburban schools in Rochester. Since then, it has been implemented in more than 500 sites throughout the Unites States and internationally, serving more than 20,000 children worldwide. The developer and colleagues have conducted eight studies of program effectiveness in the United States. Internationally, studies have been conducted in Canada, Cyprus, Germany, Portugal, and South Africa, and a large pilot study is currently underway in the Netherlands.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: No Evaluated in comparative effectiveness research studies: No
Adaptations	CODIP has been translated into Dutch, French, German, and Turkish. Most adaptations have been developed for use in schools, but an ongoing clinical trial in the Netherlands has adapted the program for young children in an outpatient community mental health center.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	Selective

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Outcomes

Outcome 1: School-related behaviors and competencies
Description of Measures	Children's school-related behaviors and competencies were assessed using three instruments: the Classroom Adjustment Rating Scale (CARS), the Health Resources Inventory (HRI), and the Teacher-Child Rating Scale (T-CRS). The CARS is a 41-item measure of classroom teachers' perception of children's problem behaviors. It measures three factors: Acting Out, Shy-Anxious, and Learning Problems. Items are rated on a 5-point severity scale from 1 (not a problem) to 5 (very serious problem). The HRI is a 54-item measure of classroom teacher's assessment of children's social competence and adaptability. It includes five subscales: Good Student, Adaptive Assertiveness, Peer Sociability, Follows Rules, and Frustration Tolerance. Items are scored on a 5-point scale from 1 (not at all) to 5 (very well). The T-CRS, also completed by teachers, consists of two parts. Part 1 includes three 5-item factored scales measuring the teachers' perception of children's problem classroom behaviors: Acting-Out, Shy/Anxious, and Learning Problems. Part 2 includes four 5-item factored scales measuring the teachers' perception of children's school-related competencies: Frustration Tolerance, Assertiveness, Peer Social Skills, and Task Orientation. For each item, teachers indicate the extent to which the item describes the child, from 1 (not at all) to 5 (very well).
Key Findings	In one study, children of divorced/separated parents were randomly assigned to either the intervention group or the delayed intervention group. Children receiving CODIP demonstrated significant improvement in problem behaviors compared with children in the control group, as rated by teachers completing the CARS (p < .001). Children in the CODIP group also showed significant increases in social competence and adaptability compared with children in the control group, as rated by teachers completing the HRI (p < .001). Two studies compared three groups: an intervention group of children with divorced/separated parents, a no-treatment control group of children with divorced/separated parents, and a no-treatment comparison group of children whose parents were not divorced/separated. Findings included the following: In one study, children receiving CODIP demonstrated significant improvement in school-related problem behaviors and competencies compared with children in the divorce control group and intact comparison group (p < .05), as rated by teachers completing the T-CRS. In the other study, children receiving CODIP did not show a significant improvement in school-related problem behaviors and competencies compared with children in the divorce control group or intact comparison group, as rated by teachers completing the T-CRS.
Studies Measuring Outcome	Study 1, Study 2, Study 3
Study Designs	Experimental, Quasi-experimental
Quality of Research Rating	2.7 (0.0-4.0 scale)

Outcome 2: Behavioral and emotional adjustment to divorce
Description of Measures	Children's behavioral and emotional adjustment was assessed using two instruments developed by the study authors: the Parent Evaluation Form (PEF) and the Group Leader Evaluation Form (GLEF). The PEF measures parent perceptions of children's feelings and problem-solving skills. One study used the original 14-item version, and the other studies used the 20-item version. The PEF assesses children's school performance, peer relationships, and feelings about the divorce. All items are rated on a 4-point scale from 1 (very true of my child) to 4 (not at all true of my child). The GLEF was used in the intervention groups to assess group leader perceptions of children's attitudes and behaviors related to divorce. The GLEF includes two 8-item sections. Section 1 describes problems the children may appear to be experiencing, with items rated on 4-point scale from 1 (not a problem) to 4 (very serious problem). Section 2 describes competencies, each rated on a 4-point scale from 1 (not at all) to 4 (very well).
Key Findings	In one study, children of divorced/separated parents were randomly assigned to either the intervention group or the delayed intervention group. Children receiving CODIP showed significant improvement in their adjustment compared with children in the control group, as rated by parents completing the PEF (p < .001). Children receiving CODIP had a significant improvement in adjustment, as rated by group leaders completing the GLEF (p < .001). Two studies compared three groups: an intervention group of children with divorced/separated parents, a no-treatment control group of children with divorced/separated parents, and a no-treatment comparison group of children whose parents were not divorced/separated. In each of these two studies, children receiving CODIP had significant improvement in adjustment compared with children in the divorce control group and intact comparison group, as rated by parents completing the PEF (p < .001). In both studies, children receiving CODIP had a significant improvement in adjustment, as rated by group leaders completing the GLEF (p < .001).
Studies Measuring Outcome	Study 1, Study 2, Study 3
Study Designs	Experimental, Quasi-experimental
Quality of Research Rating	2.5 (0.0-4.0 scale)

Outcome 3: Anxiety
Description of Measures	Children's anxiety was measured using the 20-item Trait scale of the State-Trait Anxiety Inventory for Children (STAIC). The Trait scale asks children to rate themselves on the frequency of occurrence of 20 specific feelings (e.g., "I worry about my parents," "I feel like crying") using a 3-point scale from 1 (hardly ever) to 3 (often).
Key Findings	In one study, children of divorced/separated parents were randomly assigned to either the intervention group or the delayed intervention group. Children receiving CODIP had a significant decrease in self-reported anxiety compared with children in the control group (p < .02). Another study compared three groups: an intervention group of children with divorced/separated parents, a no-treatment control group of children with divorced/separated parents, and a no-treatment comparison group of children whose parents were not divorced/separated. Children receiving CODIP had a significant decrease in self-reported anxiety compared with children in the divorce control group and intact comparison group (p < .01).
Studies Measuring Outcome	Study 1, Study 3
Study Designs	Experimental, Quasi-experimental
Quality of Research Rating	2.6 (0.0-4.0 scale)

Outcome 4: Attitudes and feelings about family
Description of Measures	Children's attitudes and feelings about family were measured using three instruments: Children's Attitudes and Self-Perceptions (CASP), developed by the study authors, is a 15-item self-report measure of children's divorce-related attitudes and self-perceptions, measured on a 4-point scale from 1 (very true for me) to 4 (not at all true for me). The CASP includes specific divorce-related items (e.g., "It's OK for me to talk with my friends about my parents' separation") and items that reflect intervention goals (e.g., "If I have a problem, I can figure out how to solve it"). Children's Divorce Adjustment Scale (CDAS), developed by the study authors, is a 17-item self-report measure assessing children's feelings about their families, their parents, themselves, and their coping skills. Children rate items on a 3-point scale (1 = usually yes, 2 = sometimes, 3 = usually no). Children's Family Adjustment Scale (CFAS) is a 17-item (originally 16-item) self-report measure of children's feelings about their family, themselves, and their support system. Responses are based on a 3-point scale (1 = no, 2 = sometimes, 3 = yes).
Key Findings	In one study, children of divorced/separated parents were randomly assigned to either the intervention group or the delayed intervention group. No significant difference was found between the two groups in children's self-reported attitudes and self-perceptions, as rated by the CASP. Two studies compared three groups: an intervention group of children with divorced/separated parents, a no-treatment control group of children with divorced/separated parents, and a no-treatment comparison group of children whose parents were not divorced/separated. Findings included the following: In one study, children receiving CODIP had a significant improvement in self-reported attitudes and self-perceptions compared with children in the divorce control group and intact comparison group, as rated by the CDAS (p < .001). In the other study, children receiving CODIP had a significant improvement in self-reported attitudes and self-perceptions compared with children in the divorce control group and intact comparison group, as rated by the CFAS (p < .01) and the CASP (p < .01).
Studies Measuring Outcome	Study 1, Study 2, Study 3
Study Designs	Experimental, Quasi-experimental
Quality of Research Rating	2.5 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	6-12 (Childhood)	56% Male 44% Female	100% White
Study 2	6-12 (Childhood)	53.5% Male 46.5% Female	69% White 23% Black or African American 5% Hispanic or Latino 3% Race/ethnicity unspecified
Study 3	6-12 (Childhood)	58.5% Male 41.5% Female	56% White 30% Black or African American 10% Hispanic or Latino 3.6% Asian 0.4% American Indian or Alaska Native

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: School-related behaviors and competencies	2.0	2.8	2.0	3.6	2.5	3.4	2.7
2: Behavioral and emotional adjustment to divorce	2.4	2.0	2.0	3.7	2.3	2.9	2.5
3: Anxiety	2.3	2.7	2.0	3.8	2.3	2.8	2.6
4: Attitudes and feelings about family	2.1	2.0	2.0	3.7	2.3	2.9	2.5

Study Strengths

Some of the studies' instruments have good internal consistency and test-retest reliability. Study attrition was minimal in one study and nonexistent in the two others. Appropriate mechanisms were put in place to maximize intervention fidelity (e.g., group leaders received extensive training before the program start, weekly feedback and supervisory meetings were held for them during implementation). Missing data were not an issue. In two of the studies, the study design was enhanced by comparing three groups of children: those who had divorced/separated parents and received the intervention, those who had divorced/separated parents and did not receive the intervention, and those whose parents were not divorced/separated. The analysis strategy was very sound. Researchers controlled for the inequalities across groups that were noted on key variables at baseline.

Study Weaknesses

Some of the studies' instruments (the CDAS, CASP, PEF, and GLEF) were developed by the authors and do not have fully established psychometric properties. Two of the studies did not randomize the students, thereby introducing potential selection bias. No systematic data were reported regarding adherence to the curriculum or the quality of program delivery. The attendance rate of the students was not provided. The teachers, parents, and group leaders who assessed the children were not blind to study condition. The small sample size in one study did not permit examination of data by demographic or other variables. Clustering effects at the school level were not accounted for, but in all likelihood the effects of these, if any, would have been trivial.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Pedro-Carroll, J. Children of Divorce Intervention Program: A procedures manual for conducting support groups, fourth-sixth grade children. Rochester, NY: Children's Institute.

Pedro-Carroll, J., & Alpert-Gillis, L. Children of Divorce Intervention Program: A procedures manual for conducting support groups, kindergarten & first grade children. Rochester, NY: Children's Institute.

Pedro-Carroll, J., Alpert-Gillis, L., & Sterling, S. Children of Divorce Intervention Program: A procedures manual for conducting support groups, second & third grade children. Rochester, NY: Children's Institute.

Pedro-Carroll, J., Sutton, S. E., & Black A. E. Children of Divorce Intervention Program: A procedures manual for conducting support groups, seventh & eighth grade students. Rochester, NY: Children's Institute.

Phoenix Learning Group. Tender places [DVD]. St. Louis, MO.

Other program materials:

Comments About Group Form
Daring Dinosaurs game
Feelings poster
Group Leader Evaluation Form
Group Process Form
Quality Assurance Protocol
Teacher-Child Rating Scale (T-CRS)
Resources for Training and Program Consultation

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
3.2	2.9	2.3	2.8

Dissemination Strengths

Implementation materials are well organized and user-friendly. Program information, packaged for use with specific grades, is developmentally appropriate for the students' age while staying within a common theoretical framework. Guidance is logical, and detailed instruction is balanced with more general guidance that might be helpful to implementers in adapting the program to fit specific needs. Training and consultation are available from the program developers, and the program Web site provides comprehensive training resources. Forms are provided that group leaders can use to gauge their adherence to program sequencing and content. An instrument for evaluating children's behavior and social/emotional competencies is also available.

Dissemination Weaknesses

Written guidance on organizational readiness, including how to prepare for implementation, identify individuals who should be involved in implementation, and manage the program on an ongoing basis, is not fully developed. There is no training manual separate from implementation materials. Quality assurance materials are difficult to distinguish from other program materials. Clear guidance is not provided on how and when to use the quality assurance tools or on how to use the data collected through quality assurance efforts.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
Program manuals	$125 per manual or $225 per pair of manuals (grades K and 1 plus grades 2 and 3 or grades 4-6 plus grades 7 and 8)	Yes
1-day, on- or off-site training	$2,500 per site (plus trainer's travel expenses if on site)	No
Consultation	$1,000 per day	No
Program evaluation	Approximately $20,000, but rates vary depending on the scope and nature of the evaluation	No