A History of Child and Adolescent Treatment Through a Distillation Lens: Looking Back to Move Forward

Pilot study of implementing Managing and Adapting Practice in a German psychotherapy master's program

Despite a significant accumulation of research, there has been little systemic implementation of evidence-based practices (EBP) in youth mental health care. The fragmentation of the evidence base complicates implementation efforts. In light of this challenge, we sought to pilot a system that consolidates and coordinates the entire evidence base in a single direct service model (i.e., Managing and Adapting Practice; MAP) in the context of a legal reform of psychotherapy training in Germany. This pilot study aimed to evaluate the feasibility of the implementation of MAP into the curriculum of the reformed German master's program. Eligible participants were students in the master's program at Philipps-University Marburg during the winter-term 2022/2023. Students first learned about MAP through introductions and role plays (seminar 1), followed by actively planning and conducting interventions using MAP resources for patients in a case seminar under supervision (seminar 2). A repeated-measures survey was conducted to investigate students' knowledge gains, perception of MAP and changes in their self-rated confidence to use EBP. Results indicated that students perceive MAP to be manageable to learn. Positive progress was achieved with regard to their knowledge and self-reported confidence to use EBP, although interpretation and generalization of the results are limited by small and homogeneous samples, lack of statistical power and missing comparison groups. The feasibility of the implementation and suitability of measures are discussed. Important implications could be drawn with regard to future investigations.

Common Elements Approaches to Implementation Research and Practice: Methods and Integration with Intervention Science

We propose that common elements approaches can advance implementation research and practice and facilitate pragmatic use of intervention and implementation evidence. Common elements are practices or processes frequently shared by interventions or implementations. Traditional common elements methodologies use synthesis, distillation, and statistics to describe and evaluate the merit of common ingredients in effective interventions. Recent developments include identifying and testing common configurations of elements, processes, and context variables across the literature of effective interventions and implementations. While common elements thinking has grown popular in intervention science, it has rarely been utilized in implementation science, and specifically, combined with the intervention literature. The goals of this conceptual methodology paper are to (1) provide an overview of the common elements concept and how it may advance implementation research and usability for practice, (2) give a step-by-step guide to systematic common elements reviews that synthesizes and distills the intervention and implementation literature together, and (3) offer recommendations for advancing element-level evidence in implementation science. A narrative review of the common elements literature was conducted with attention to applications to implementation research. A six-step guide to using an advanced common elements methodology was provided. Examples of potential results are presented, along with a review of the implications for implementation research and practice. Finally, we reviewed methodological limitations in current common elements approaches, and identified steps towards realizing their potential. Common elements methodologies can (a) synthesize and distill the implementation science literature into practical applications, (b) generate evidence-informed hypotheses about key elements and determinants in implementation and intervention processes and mechanisms, and (c) promote evidence-informed precision tailoring of intervention and implementation to context. To realize this potential, common elements approaches need improved reporting of details from both successful and unsuccessful intervention and implementation research, more data availability, and more testing and investigation of causal processes and mechanisms of change from diverse theories.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43477-023-00077-4.

Elements in Mental Health Interventions Associated with Effects on Emotion Regulation in Adolescents: A Meta-Analysis

PURPOSE

Adolescence is a sensitive period for developing mental health problems. Interventions targeting emotion regulation have shown promising transdiagnostic effects for this group, but optimization efforts are called for. In the current study, we used an element-based approach to identify potentially active ingredients in interventions measuring emotion regulation, to guide further optimization.

METHODS

We coded practice elements in 30 studies based on a systematic review of mental health interventions measuring emotion regulation in adolescents (N = 2,389 participants, mean age 13-17 years). Using a three-level modeling approach, we then investigated the difference in effect on emotion regulation between studies of interventions with and without these practice elements.

RESULTS

We identified 75 practice elements and 15 element categories used in the included interventions. Results showed significantly stronger effects on emotion regulation when interventions included the practice elements Setting goals for treatment (difference in d = 0.40, 95% CI [0.09, 0.70], p = .012) and Psychoeducation about acceptance (difference in d = 0.58, 95% CI [0.09, 1.07], p = .021). Furthermore, a total of 11 elements and four overall categories were identified as potentially active ingredients, based on an effect size difference of > 0.20 between interventions with and without the elements.

CONCLUSION

The results can direct experimental research into the selection of practices that are most likely key to mechanisms of change in interventions addressing emotion regulation for adolescents. The challenge of measuring emotion regulation is discussed.

A Modular, Transdiagnostic Approach to Treating Severe Irritability in Children and Adolescents

Severe irritability is common in treatment-referred youth, often occurring in externalizing, anxiety, and mood conditions. The best available evidence indicates behavioral parent training and cognitive-behavioral therapy as first-line interventions. Modular approaches (eg, MATCH) can package these strategies in a flexible format, facilitating personalization. Ample evidence supports MATCH's effectiveness generally and initial evidence supports its effectiveness for irritability specifically. We provide an overview of MATCH and its application to severe irritability. Emphasis is placed on behavioral parent training as a likely primary/first-line treatment. Potential benefits and limitations are considered. This approach calls for careful clinical judgment and for further empirical research.

Identifying intervention strategies for preventing the mental health consequences of childhood adversity: A modified Delphi study

Exposure to childhood adversity is a powerful risk factor for psychopathology. Despite extensive efforts, we have not yet identified effective or scalable interventions that prevent the emergence of mental health problems in children who have experienced adversity. In this modified Delphi study, we identified intervention strategies for effectively targeting both the neurodevelopmental mechanisms linking childhood adversity and psychopathology - including heightened emotional reactivity, difficulties with emotion regulation, blunted reward processing, and social information processing biases, as well as a range of psychopathology symptoms. We iteratively synthesized information from experts in the field and relevant meta-analyses through three surveys, first with experts in intervention development, prevention, and childhood adversity (n = 32), and then within our study team (n = 8). The results produced increasing stability and good consensus on intervention strategy recommendations for specific neurodevelopmental mechanisms and symptom presentations and on strength of evidence ratings of intervention strategies targeting youth and parents. More broadly, our findings highlight how intervention decision making can be informed by meta-analyses, enhanced by aggregate group feedback, saturated before consensus, and persistently subjective or even contradictory. Ultimately, the results converged on several promising intervention strategies for prevention programming with adversity-exposed youth, which will be tested in an upcoming clinical trial.

Common Elements of Practice, Process and Implementation in Out-of-School-Time Academic Interventions for At-risk Children: a Systematic Review

Academic achievement is a strong preventive factor against marginalization. Children at risk of academic failure and drop out can benefit from out-of-school-time academic (OSTA) interventions. Wide-scaled implementation and sustainment of effective interventions remain a struggle across education, welfare, and health. The need for approaches to increase implementability, effectiveness, and efficiency of interventions is pressing. Advancements in the field of education and mental health suggest identifying and studying discrete elements that are common across interventions for the purpose of hypothesis generation, intervention optimization, design improvement, and implementation. This review identified OSTA interventions for primary school children at risk of academic failure. Common elements methodology was used to code practice elements (n = 62), process elements (n = 49), and implementation elements (n = 36) in 30 effective and six ineffective OSTA interventions in matrices. Based on frequency counts, common practice, process, and implementation elements across the interventions were identified, and given frequency count values (FV) reflecting how often elements were included in effective studies as opposed to in ineffective studies. The five common practice elements with the highest FVs were homework support, training in positive parental school involvement, positive reinforcement, structured tutoring, and psychoeducation. The most common process element was regular support to intervention receiver, and the most common implementation element was quality monitoring. Common combinations of elements were also identified and given FVs. Results from this review can inform efforts to design or optimize OSTA interventions, and inform education, implementation, and practice to improve academic achievement for children at risk.