Evidence‐based protocols: Merits, drawbacks, and potential solutions

Targeting Caregiver Psychopathology in Parent Management Training for Adolescents: A Scoping Review of Commercially Available Treatment Resources

Background

While parent management training (PMT) has been shown to be an effective treatment for adolescents with externalizing concerns, evidence suggests that effectiveness is not equitable across all types of families. Research suggests that caregiver psychopathology may adversely affect PMT success for adolescents. However, it remains unclear whether research on caregiver psychopathology is integrated within adolescent PMT resources (e.g., treatment manuals).

Objective

A scoping review of commercially available, clinician focused PMT resources was conducted to assess for information on caregiver psychopathology and clinical guidance for addressing caregiver psychopathology.

Methods

A search for commercially available resources was conducted among national treatment databases and book resource websites. Information on caregiver psychopathology was extracted from individual sessions of the PMT resources.

Results

Seven treatment resources met inclusion criteria. The majority of the treatment resources made at least one explicit comment that caregiver psychopathology may impact the course of treatment. There was very limited mention of caregiver psychopathology in skill building sections of the resources.

Conclusions

While most resources mentioned caregiver psychopathology, these comments lacked breadth and depth in providing clinicians with recommendations on how to tailor treatment to caregivers' needs. Recommendations are provided for how PMT programs might be improved in the future to support clinicians when faced with caregiver psychopathology by recognizing inequities and lack of diversity in resource development, using a transdiagnostic perspective (including a transdiagnostic approach to assessment of care-giver psychopathology), and integrating caregiver skill development.

How Flexible are Treatments for Youth Internalizing Disorders? Examining Modification Guidelines Included across Supported Treatments

OBJECTIVE

Treatment protocols for youth-internalizing disorders have been developed, however these protocols have yielded mixed findings in routine care settings. Despite increased recognition of the importance of flexibility when delivering evidence-based treatments (EBTs), little is known about the extent to which protocols offer guidance to providers in flexible EBT implementation. The current study examined the extent to which supported EBTs for youth internalizing disorders explicitly incorporate guidance for treatment modification.

METHODS

Supported treatment protocols for youth internalizing disorders were identified (N = 44), from which 4,021 modification guidelines were extracted and coded using a structured coding system to classify modification strategies (i.e., the forms that recommended modifications take), and associated tailoring factors (i.e., the rationale for which modifications are recommended).

RESULTS

Across all EBTs, modification guidelines were quite common, with the average protocol including almost 91 text passages providing guidance for modification. The majority of modification guidelines functionally increase session or treatment length by recommending the addition or repetition of material, whereas less than 5% of modification guidelines provided strategies for condensing or streamlining care. Strikingly, less than 2% of modification guidelines in EBT protocols address patient cultural factors, and rarely address provider or setting issues that can challenge standard implementation.

CONCLUSIONS

Findings highlight critical gaps in the available guidance to modify EBTs for youth internalizing disorders, and suggest EBT protocols may not be optimally poised to flexibly address the broad diversity of children and adolescents across varied settings in need of mental health care.

Trauma Education and Stigma Reduction in Global Settings: An Evaluation of the Impact of a One-Day Trauma Psychoeducation Workshop with Community Stakeholders in the Caribbean Nation of Saint Lucia

The independent island nation of Saint Lucia and surrounding Caribbean countries have fairly well-documented high reported rates of trauma, but limited training infrastructure for trauma-related mental health support and treatment services. This study addresses this disparity between high trauma exposure and sparse trauma-related resources by studying how a one-day training workshop impacted self-rated knowledge about trauma and stigma towards trauma survivors. The training was provided by a licensed clinical psychologist in partnership with a local women's rights group. Participants (n = 41) included school counselors, nurses, psychiatric providers, health educators, and advocates on the island. Participants completed pre- and post-workshop measures examining the variables of interest. The one-day workshop provided training on trauma types, post-trauma reactions, options for treatment, and hands-on training for trauma crisis-management and short-term interventions. Following the workshop, participants reported increased knowledge of trauma, more accurate perceptions of its prevalence, better understanding of evidence-based treatments, and lower trauma survivor-related stigma. This is the first trauma-focused workshop tested in St. Lucia, where the need for such training is considerable given few treatment options for trauma survivors in this area. Work is underway to provide more expansive services for trauma across the Caribbean region, given these preliminary promising findings.