Understanding the common elements of evidence-based practice: misconceptions and clinical examples

Community vs. clinic-based modular treatment of children with early-onset ODD or CD: a clinical trial with 3-year follow-up

This study examines the treatment outcomes of 139, 6-11 year-old, clinically referred boys and girls diagnosed with Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) who were randomly assigned to a modular-based treatment protocol that was applied by research study clinicians either in the community (COMM) or a clinic office (CLINIC). To examine normative comparisons, a matched sample of 69 healthy control children was included. Multiple informants completed diagnostic interviews and self-reports at six assessment timepoints (pretreatment to 3-year follow-up) to evaluate changes in the child's behavioral and emotional problems, psychopathic features, functional impairment, diagnostic status, and service involvement. Using HLM and logistic regression models, COMM and CLINIC showed significant and comparable improvements on all outcomes. By 3-year follow-up, 36% of COMM and 47% of CLINIC patients no longer met criteria for either ODD or CD, and 48% and 57% of the children in these two respective conditions had levels of parent-rated externalizing behavior problems in the normal range. We discuss the nature and implications of these novel findings regarding the role of treatment context or setting for the treatment and long-term outcome of behavior disorders.

Common factors in effective HIV prevention programs

We propose a set of common factors in evidence-based interventions (EBI) for HIV prevention, which cut across theoretical models of behavior change. Three existing literatures support this agenda: (1) Common factors in psychotherapy; (2) core elements from the Centers for Disease Control and Prevention EBIs; and (3) component analyses of EBI. To stimulate discussion among prevention researchers, we propose a set of common factors at the highest level of abstraction that describe what all effective programs do: (1) establish a framework to understand behavior change; (2) convey issue-specific and population-specific information necessary for healthy actions; (3) build cognitive, affective, and behavioral self-management skills; (4) address environmental barriers to implementing health behaviors; and (5) provide tools to develop ongoing social and community support for healthy actions. A focus on common factors will enhance research on new HIV prevention interventions, encourage collaboration among researchers, provide guidelines for adapting EBI, and simplify and speed the adoption of EBI for providers.

Common principles embedded in effective adolescent HIV prevention programs

Each interpersonally delivered, evidence-based (EB) program for HIV prevention shares common features that aim to shift HIV risk behaviors. We used qualitative research methods to examine manuals from five EB programs for adolescents and identified 10 core principles embedded in each program's activities. Principles reflect the stated goals and anticipated lessons in an activity. The principles were: Believe in your own worth and your right to a happy future; Commit to change; Distinguish fact from myth; Plan ahead and be prepared; Practice self-control; Know pleasurable alternatives to high risk activities; Negotiate verbally, not nonverbally; Evaluate options and consequences; Show concern for others; Choose to limit your own freedom; and Act to help others protect themselves. Focusing on common features rather than the unique properties of each EB program may allow community providers to have more flexibility and ownership in adapting EB programs, and may also facilitate development of new EB program.

Family-based treatment for adolescent substance abuse: controlled trials and new horizons in services research

This article provides an overview of controlled trials research on treatment processes and outcomes in family-based approaches for adolescent substance abuse. Outcome research on engagement and retention in therapy, clinical impacts in multiple domains of adolescent and family functioning, and durability and moderators of treatment effects is reviewed. Treatment process research on therapeutic alliance, treatment fidelity and core family therapy techniques, and change in family processes is described. Several important research issues are presented for the next generation of family-based treatment studies focusing on delivery of evidence-based treatments in routine practice settings.

The future of psychotherapy for mentally ill children and adolescents

OBJECTIVE

Given striking advances in translational developmental neuroscience and its convergence with developmental psychopathology and developmental epidemiology, it is now clear that mental illnesses are best thought of as neurodevelopmental disorders. This simple fact has enormous implications for the nature and organization of psychotherapy for mentally ill children, adolescents and adults.

METHOD

This article reviews the 'trajectory' of psychosocial interventions in pediatric psychiatry, and makes some general predictions about where this field is heading over the next several decades.

RESULTS

Driven largely by scientific advances in molecular, cellular and systems neuroscience, psychotherapy in the future will focus less on personal narratives and more on the developing brain. In place of disorders as intervention targets, modularized psychosocial treatment components derived from current cognitive-behavior therapies will target corresponding central nervous system (CNS) information processes and their functional behavioral consequences. Either preventive or rehabilitative, the goal of psychotherapy will be to promote development along typical developmental trajectories. In place of guilds, psychotherapy will be organized professionally much as physical therapy is organized today. As with other forms of increasingly personalized health care, internet-based delivery of psychotherapy will become commonplace.

CONCLUSION

Informed by the new field of translational developmental neuroscience, psychotherapy in the future will take aim at the developing brain in a service delivery model that closely resembles the place and role of psychosocial interventions in the rest of medicine. Getting there will be, as they say, interesting.

Disseminating and Implementing Trauma-focused CBT in community settings

Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based practice (EBP) for children. TF-CBT is being disseminated and implemented through a variety of strategies, including distance learning/ Internet training, live training + ongoing phone consultation, a learning collaborative model, and mixed models. Each dissemination and implementation model is described, examples are provided of how it has been used to spread the TF-CBT model among community clinicians treating traumatized children, and data regarding its use are presented. Quality and quantity of data from these dissemination/ implementation models varies, but overall they supports the effectiveness of both the TF-CBT model in treating traumatized children and a variety of dissemination and implementation models. More research is needed to learn about optimal strategies for disseminating and implementing EST for traumatized children, and to explore novel methodologies (e.g., including training in EST for traumatized children in graduate programs).

Research on transition to adulthood: building the evidence base to inform services and supports for youth and young adults with serious mental health disorders

Since the mid-1990s, research has established a clear picture of the poor real-life outcomes achieved by transition-age youth and young adults who have been diagnosed with a serious mental health disorder. The purpose of this article is to: (1) introduce the reader to the other eight articles in this special issue on Transition to Adulthood Research; (2) illustrate how each is contributing to the research base available to more fully understand these challenges as well as guide the creation of developmentally appropriate and effective services and supports for youth and young adults and their families; and (3) suggest future directions for continuing to advance this field of research and program implementation to improve outcomes though practice and policy improvements.

Community treatment of child sexual abuse: a survey of practitioners in the National Child Traumatic Stress Network

Practitioners from numerous agencies who sought training in Trauma-Focused Cognitive-Behavioral Therapy in several regional sites under the auspices of the National Child Traumatic Stress Network completed a baseline survey to describe their backgrounds, settings, practices, attitudes, and perceived outcomes with sexually abused children and youth. The results documented a range of experiences and common treatment practices, and identified contributors to practitioners' use of gradual exposure and perceived levels of positive treatment outcome. The results were not accounted for by geographic region or agency. The findings support recommendations to optimize research and training related to the dissemination of evidence-based treatments in the child abuse field.

Identifying common elements of evidence-based psychosocial treatments for children's disruptive behavior problems

OBJECTIVE

: Almost all of the efforts to study and implement evidence-based practice (EBP) have used individual treatments as the unit of analysis. A complementary approach using aggregated common elements of multiple individual evidence-based treatment programs has been introduced. The purpose of this article is to describe a new method for identifying common elements of EBP and to present common elements resulting from a systematic review of interventions for children with disruptive behavior problems and their parents.

METHOD

: We identified eight individual treatment programs with established efficacy for children ages 4 to 13 with disruptive behavior problems, reviewed all of the treatment materials thoroughly, identified core elements of each treatment, and determined which elements were common to at least half of the programs. The validity of these common core elements was confirmed through a survey of national experts using a modified Delphi technique.

RESULTS

: We identified 21 treatment elements that were common to multiple evidence-based treatment programs. These included therapeutic content (e.g., principles of positive reinforcement, problem-solving skills training), treatment techniques (e.g., role-playing, assigning homework), aspects of the working alliance, and other parameters such as treatment duration.

CONCLUSIONS

: Identification of common core elements of EBP has important implications for efforts to characterize practice, as well as therapist training and implementation of EBP in community-based service settings. Therapist training and ongoing supervision that builds on common elements of EBP could potentially improve the effectiveness of care overall. It could also build a strong foundation for targeted individual treatment implementation efforts by enhancing therapists' skills and attitudes about EBP.