Evidence‐based treatments for children and adolescents: An updated review of indicators of efficacy and effectiveness

Advances in Applying Treatment Integrity Research for Dissemination and Implementation Science: Introduction to Special Issue

This special series focuses upon the ways in which research on treatment integrity, a multidimensional construct including assessment of the content and quality of a psychosocial treatment delivered to a client as well as relational elements, can inform dissemination and implementation science. The five articles for this special series illustrate how treatment integrity concepts and methods can be applied across different levels of the mental health service system to advance dissemination and implementation science. In this introductory article, we provide an overview of treatment integrity research and describe three broad conceptual models that are relevant to the articles in the series. We conclude with a brief description of each of the five articles in the series.

Modular Cognitive-Behavioral Treatment of an Adolescent Female With Selective Mutism and Social Phobia

Selective mutism (SM), a debilitating disorder usually appearing in childhood, is diagnosed when an individual capable of speaking fails to speak in social situations in which there is an expectation for the individual to speak. There is very little empirical research on the assessment and treatment of SM in adolescents and adults. The case presented in this article applies a developmental adaptation of a modular cognitive-behavioral therapy approach to treat an adolescent female with SM and social phobia. The treatment consisted of 61 sessions, including sessions on psychoeducation, cognitive restructuring, relaxation, exposure, social skills, and parent training. The presenting symptoms, assessment strategy, and treatment elements are covered in detail. The client’s symptoms were assessed via fear hierarchy ratings, self-report and parent-report measures, and client and parent clinical interviews.

The Timing of Exposure in Clinic-Based Treatment for Childhood Anxiety Disorders

The present study examines treatment length and timing of exposure from two child anxiety disorders clinics. Data regarding symptoms and treatment characteristics for 28 youth were prospectively obtained through self, parent, and therapist report at each session. Information regarding length of treatment, timing of exposure initiation, and drop-out rates were compared with those obtained through efficacy and effectiveness trials of manualized treatment for anxious youth. Findings from the authors’ clinical data revealed significantly shorter treatment duration with exposures implemented sooner than in the previous studies. Dropout rates were significantly higher than in the efficacy trial but comparable with the effectiveness trial. Outcome data from a subset of eight patients revealed large effect sizes. These findings suggest that effective treatment can be shorter and more focused on exposure than is often outlined in manuals and have important implications for outcome research and dissemination.

A Model for Sustainable Development of Child Mental Health Infrastructure in the LMIC World: Vietnam as a Case Example

Children and adolescents are among the highest need populations in regards to mental health support, especially in low and middle income countries (LMIC). Yet resources in LMIC for prevention and treatment of mental health problems are limited, in particular for children and adolescents. In this paper, we discuss a model for development of child and adolescent mental health (CAMH) resources in LMIC that has guided a ten year initiative focused on development of CAMH treatment and research infrastructure in Vietnam. We first review the need for development of mental health resources for children and adolescents in general, and then in Vietnam. We next present the model that guided our program as it developed, focused on the twin Capacity Development Goals of efficacy and sustainability, and the Capacity Development Targets used to move towards these goals. Finally we discuss our CAMH development initiative in Vietnam, the center of which has been development of a graduate program in clinical psychology at Vietnam National University, linking program activities to this model.