Toward large-scale implementation of empirically supported treatments for children: A review and observations by the Hawaii Empirical Basis to Services Task Force

Validating a Pragmatic Measure of Evidence-Based Practice (EBP) Delivery: Therapist Reports of EBP Strategy Delivery and Associations with Child Outcome Trajectories

Pragmatic measures of evidence-based practice (EBP) implementation can support and evaluate implementation efforts. We examined the predictive validity of therapist reports of EBP strategy delivery for children's mental health outcomes. Data were obtained from 1,380 sessions with 248 children delivered by 76 therapists in two county systems. Children (Mage=11.8 years, SD = 3.7) presented with internalizing (52%), externalizing (27%), trauma (16%), and other (5%) concerns. Therapists reported their delivery of EBP strategies on a revised version of the EBP Concordant Care Assessment (ECCA; Brookman-Frazee, et al., Administration and Policy in Mental Health and Mental Health Services Research, 48, 155-170, 2021) that included 25 content (e.g., parenting, cognitive behavioral) and 12 technique strategies (e.g., modeling, practice/role-play). On average, 5.6 ECCA session reports (SD = 2.3) were obtained for each client, and caregivers reported symptoms on the Brief Problem Checklist (Chorpita, et al., Journal of Consulting and Clinical Psychology, 78(4), 526-536, 2010) at baseline, weekly over two months, and again at four months. Multilevel models examined whether the mean extensiveness of each EBP strategy predicted trajectories of child outcomes. More individual technique (6 of 12) than content strategies (1 of 25) were associated with outcome trajectories. For techniques, more extensive use of Performance Feedback and Live Coaching and less extensive use of Addressing Barriers were associated with greater declines in total symptoms, and more extensive use of Establishing/Reviewing Goals, Tracking/Reviewing Progress, and Assigning/Reviewing Homework was associated with declines in externalizing symptoms. For content, more extensive use of Cognitive Restructuring was associated with declines in total symptoms. In addition, higher average extensiveness ratings of the top content strategy across sessions was associated with greater declines in total and externalizing symptoms. Therapist-reported delivery of some EBP strategies showed evidence of predictive validity and may hold utility in indexing quality of care.

Science for behavioral health systems change: evolving research-policy-public partnerships

Potent partnerships among researchers, policymakers, and community members have potential to produce positive changes in communities on a range of topics, including behavioral health. The paper provides a brief illustrative review of such partnerships and then describes the development and evolution of one partnership in particular in Virginia. The origin of the partnership is traced, along with its founding vision, mission, and values. Some of its several projects are described, including (a) needs assessment for implementation of evidence-based programs (EBPs) pursuant to the Family First Prevention Services Act; (b) statewide fidelity monitoring of key EBPs; and (c) projects to synergize state investments in specific EBPs, like multisystemic therapy, functional family therapy, and high fidelity wraparound. The paper concludes with some themes around which the center has evolved to serve the state and its citizens more effectively.

Implementation of Evidence-Based Practices within Treatment-As-Usual and Evidence-Based Practice Initiatives

Publicly funded initiatives are underway to improve implementation of evidence-based practices (EBP) in youth mental health services. However, we know little about the success of these initiatives or about EBP implementation independent of such initiatives. We examined EBP implementation in a treatment as usual (TAU) state and in six states with publicly funded EBP initiatives (EBPIs). In Study 1, we examined providers' use of practices derived from the evidence base (PDEB) and their predictors among 780 providers in a TAU state. In Study 2, we conducted a systematic review of implementation strategies, outcomes, and predictors of EBP use in six state funded EBPIs. Study 1 suggests TAU providers use PDEB alongside practices without consistent research support; provider racial/ethnic minority status, learning theory orientation, and manual use predict greater PDEB use. Study 2 indicates EBPIs employ multiple recommended implementation strategies with variable outcomes across studies and measurement approaches. Predictors of EBP use in EBPIs also varied, though training, setting, and youth age were consistent predictors across studies. While sample differences and inconsistent measurement across studies made direct comparisons somewhat tenuous, rates of PDEB use in the TAU sample appeared similar to those in publicly funded EBPIs. However, two states reported comparisons with TAU samples and found higher EBP implementation under EBPI. Different predictors impacted EBP use in TAU versus EBPIs. Our findings highlight the need for improved evaluation of EBPIs including clear reporting standards for outcomes and more consistent, standardized measurement of EBP use in order to better understand and improve EBPIs.

How can services be improved to effectively address the mental health of vulnerable children and young people?

This discussion article describes a Child and Adolescent Mental Health Service (CAMHS) in the United Kingdom developed to meet the mental health needs of children and young people particularly those vulnerable children and young people at risk of actual or potential harm through child abuse and neglect, but may not be therapy ready. The aim was to improve the level of access to CAMHS for vulnerable groups and the quality and effectiveness of services for children, young people and their families.The model of service delivery is underpinned by the THRIVE Framework for System Change (THRIVE) which builds on the resilience of families and the skills of the workers who have the closest relationships with them. The article describes how a redesign was accomplished in the London Borough of Camden between 2016- 2018 to do this. Qualitative evidence of the positive impact of the changes for service users and key workers and quantitative evidence of the increased service capacity are presented. Challenges and opportunities provided by the new service model are discussed.

Using Hybrid Telepractice for Supporting Parents of Children with ASD during the COVID-19 Lockdown: A Feasibility Study in Iran

During the three-month closure of clinics and day centers in Iran due to the coronavirus disease 2019 (COVID-19) lockdown, parents of children with Autism Spectrum Disorder (ASD) became solely responsible for their care and education. Although centers maintained telephone contact, it quickly became evident that parents needed more detailed advice and guidance. Staff from 30 daycare centers volunteered to take part in a two-month online support and training course for 336 caregivers of children with ASD of different ages. In addition to the provision of visual and written information, synchronous video sessions were used to coach parents on the learning goals devised for the children. Both qualitative and quantitative data were collected to understand the acceptability of using telepractice and the outcomes achieved. A low dropout rate and positive feedback from parents indicated that they perceived telepractice sessions to be useful. The factors contributing to parents’ satisfaction were identified. Although the use of telepractice would be a good alternative for caregivers in any future lockdowns, it could also be used in conjunction with daycare center services to encourage greater parental participation, or with families living in areas with no day centers. Further studies are needed to compare telepractice to usual daycare face-to-face interventions, and to document its impact and cost-effectiveness for parents and children.

Cognitive Behavior Therapy and Metacognitive Therapy: Moderators of Treatment Outcomes for Children with Generalized Anxiety Disorder

Although cognitive behavioral therapy (CBT) is effective for childhood anxiety disorders, approximately 40% of youth remain anxious after treatment. Metacognitive therapy (MCT-c) for children with generalized anxiety disorder (GAD) has shown promising effects. The present study aimed to examine if CBT and MCT-c show differential effects in children with primary GAD based on baseline characteristics, in a quasi-experimental design. To investigate which treatment is most beneficial for whom, three potential moderators: age, symptom severity, and comorbid social anxiety were examined. Sixty-three children aged 7-14 completed CBT or MCT-c. Participants were assessed before and after treatment. Both CBT and MCT-c were highly effective in treatment of childhood GAD. None of the selected variables significantly moderated treatment outcomes. Subgroups of children with high symptom severity and social anxiety comorbidity showed trends of responding better to CBT. Methodologically stronger studies are needed to facilitate a better adaptation of treatment for children with GAD.

Cognitive Behavioral Therapy for Childhood Anxiety Disorders: a Review of Recent Advances

PURPOSE OF REVIEW

We review recent research validating cognitive behavioral therapy (CBT) as a first-line intervention for childhood anxiety disorders. We also review recent research aimed at enhancing exposure-based CBT components and adapting CBT to work with specific populations.

RECENT FINDINGS

Exposure-based CBT is a well-established intervention. Different research groups have found positive evidence to augment CBT by evaluating inhibitory learning principles, the role of parents in child treatment, an individualized case formulation, computer and online forms of CBT, and virtual and augmented reality systems for exposure practice. Specific programs have been developed to meet specific needs of preschoolers, adolescents, and children with comorbid autism spectrum disorder and anxiety. Successful adaptations to CBT exist and the field should continue to improve the generalizability, feasibility, and expected benefit of CBT to improve its effectiveness.

Working Memory and Reinforcement Schedule Jointly Determine Reinforcement Learning in Children: Potential Implications for Behavioral Parent Training

Introduction: Behavioral Parent Training (BPT) is often provided for childhood psychiatric disorders. These disorders have been shown to be associated with working memory impairments. BPT is based on operant learning principles, yet how operant principles shape behavior (through the partial reinforcement (PRF) extinction effect, i.e., greater resistance to extinction that is created when behavior is reinforced partially rather than continuously) and the potential role of working memory therein is scarcely studied in children. This study explored the PRF extinction effect and the role of working memory therein using experimental tasks in typically developing children. Methods: Ninety-seven children (age 6-10) completed a working memory task and an operant learning task, in which children acquired a response-sequence rule under either continuous or PRF (120 trials), followed by an extinction phase (80 trials). Data of 88 children were used for analysis. Results: The PRF extinction effect was confirmed: We observed slower acquisition and extinction in the PRF condition as compared to the continuous reinforcement (CRF) condition. Working memory was negatively related to acquisition but not extinction performance. Conclusion: Both reinforcement contingencies and working memory relate to acquisition performance. Potential implications for BPT are that decreasing working memory load may enhance the chance of optimally learning through reinforcement.

Parent perceptions of an adapted evidence-based practice for toddlers with autism in a community setting

Although data from parent-implemented Naturalistic Developmental Behavioral Interventions have shown positive effects on decreasing core symptoms of autism, there has been limited examination of the effectiveness of Naturalistic Developmental Behavioral Interventions in community settings. In addition, parent perspectives of their involvement in parent-implemented early intervention programs have not been well studied. Using both qualitative and quantitative data to examine parent perspectives and the perceived feasibility of parent training by community providers, 13 families were followed as they received training in the Naturalistic Developmental Behavioral Intervention, Project ImPACT. Data indicate that parent training by community providers is feasible and well received, and parents find value in participating in intervention and perceive benefit for their children. Recommendations for adaptation of program elements and future research are discussed.

Measuring Sustainment of Multiple Practices Fiscally Mandated in Children's Mental Health Services

Examining sustainment of multiple evidence-based practices is crucial to understanding the processes and outcomes of system-driven implementation efforts that are increasingly common. This study used administrative claims data to characterize volume and penetration of six practices over 19 fiscal quarters following initial implementation within the context of a system-driven, fiscally mandated implementation effort in Los Angeles County Department of Mental Health's Prevention and Early Intervention services. Patterns of volume changes over time revealed an overall ramp up of practice claims over time, but variability in patterns of volume and penetration for each practice. Findings varied by the methods used to index and analyze volume and penetration. Furthermore, a number of client case-mix and therapist characteristics were associated with the volume of therapists' claims for each practice relative to their claims for the other practices.

Factor Analysis of Therapist-Identified Treatment Targets in Community-Based Children's Mental Health

The present study used exploratory and confirmatory factor analyses to identify underlying latent factors affecting variation in community therapists' endorsement of treatment targets. As part of a statewide practice management program, therapist completed monthly reports of treatment targets (up to 10 per month) for a sample of youth (n = 790) receiving intensive in-home therapy. Nearly 75 % of youth were diagnosed with multiple co-occurring disorders. Five factors emerged: Disinhibition, Societal Rules Evasion, Social Engagement Deficits, Emotional Distress, and Management of Biodevelopmental Outcomes. Using logistic regression, primary diagnosis predicted therapist selection of Disinhibition and Emotional Distress targets. Client age predicted endorsement of Societal Rules Evasion targets. Practice-to-research implications are discussed.

Measuring Use of Research Evidence: The Structured Interview for Evidence Use

OBJECTIVES

This article describes the Standard Interview for Evidence Use (SIEU), a measure to assess the level of engagement in acquiring, evaluating, and applying research evidence in health and social service settings.

METHOD

Three scales measuring input, process, and output of research evidence and eight subscales were identified using principal axis factor analysis and parallel analysis of data collected from 202 state and county child welfare, mental health, and juvenile justice systems leaders.

RESULTS

The SIEU scales and subscales demonstrate strong internal consistency as well as convergent and discriminant validity.

CONCLUSIONS

The SIEU is easy to use and can be administered as a complete scale or as three smaller scales to separately examine evidence in acquisition, evaluation, or application. The measure demonstrates potential in understanding the role of research evidence in service settings and in monitoring the process of evidence-based practice and application of scientific principles in social work practice.

The 4KEEPS study: identifying predictors of sustainment of multiple practices fiscally mandated in children's mental health services

Background

Research to date has largely focused on predictors of adoption and initial implementation of evidence-based practices (EBPs), yet sustained implementation is crucial to deliver a return on investments in dissemination. Furthermore, most studies focus on single EBPs, limiting opportunities to study the fit between practice characteristics EBPs and implementation contexts.

Methods/design

This observational study will characterize implementation sustainment and identify organizational and therapist characteristics that predict sustainment of multiple practices being implemented within a fiscal mandate in the largest public mental health system in the USA. Specific aims are to (1) characterize sustainment outcomes (volume/penetration, EBP concordant care); (2) use mixed methods to characterize inner context (agency- and therapist-level) factors and early implementation conditions; and (3) identify inner context factors and early implementation conditions that predict sustainment outcomes. This study will undertake original data collection and analysis of existing data sources to achieve its aims. Archived reports and documents will be used to characterize early implementation conditions in 102 agencies. Administrative claims data will be used to characterize volume and penetration outcomes over 8 years. Therapist and program manager surveys will be administered to characterize sustained EBP concordant care and inner context determinants of sustainment. An in-depth study in a subset of agencies will yield interview data and recordings of treatment sessions for validation of the EBP concordant care scale.

Discussion

This project will yield new understanding of whether and how multiple EBPs can be sustained in public mental health systems undergoing a policy-driven community implementation effort. We will produce generalizable models for characterizing sustainment, including feasible and flexible measurement of practice across multiple EBPs. The findings will inform the development of implementation interventions to promote sustained delivery of EBPs to maximize their public health impact.

Electronic supplementary material

The online version of this article (doi:10.1186/s13012-016-0388-4) contains supplementary material, which is available to authorized users.

Consumer evaluation and satisfaction with individual versus group parent training for children with hyperkinetic disorder (HKD)

OBJECTIVES

The objective of this study was to investigate the social validity of cognitive-behavioural parent training (CBPT) delivered in two formats to parents who have children with hyperkinetic disorder (HKD) with and without medication.

DESIGN

Compared individual with group treatment as part of a multicentre randomized controlled trial.

METHOD

Obtained a broad range of evaluations and satisfaction ratings post-treatment and related them to pre-treatment and treatment factors.

RESULTS

Attendance rates were high in the individual and slightly less in the group training. Levels of satisfaction were high in both treatment arms with large numbers rating the outcomes, the trainers and the overall training very favourably. Medication showed no effect on parental evaluations. Evaluation of outcomes and satisfaction with the trainer emerged as strong predictors of overall programme satisfaction.

CONCLUSION

The social validity of cognitive-behavioural parent training for hyperkinetic children was supported by high levels of treatment acceptability across a range of indicators and for children with and without medication.

PRACTITIONER POINTS

Both forms of treatment delivery lead to high rates of consumer satisfaction. Consumer evaluations of CBPT appear independent of medication for HKD. Course satisfaction is clearly associated with two factors that trainers can affect: The parent-trainer relationship and parents' sense of achievement.

LIMITATIONS INCLUDE THE FOLLOWING

Far more mothers than fathers attended the trainings. Attitudes may differ in other cultures.

Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress: Lessons Learned From Prolonged Exposure Therapy for PTSD

Posttraumatic stress disorder (PTSD) poses monumental public health challenges because of its contribution to mental health, physical health, and both interpersonal and social problems. Recent military engagements in Iraq and Afghanistan and the multitude of resulting cases of PTSD have highlighted the public health significance of these conditions. There are now psychological treatments that can effectively treat most individuals with PTSD, including active duty military personnel, veterans, and civilians. We begin by reviewing the effectiveness of these treatments, with a focus on prolonged exposure (PE), a cognitive-behavioral therapy (CBT) for PTSD. Many studies conducted in independent research labs have demonstrated that PE is highly efficacious in treating PTSD across a wide range of trauma types, survivor characteristics, and cultures. Furthermore, therapists without prior CBT experience can readily learn and implement the treatment successfully. Despite the existence of highly effective treatments like PE, the majority of individuals with PTSD receive treatments of unknown efficacy. Thus, it is crucial to identify the barriers and challenges that must be addressed in order to promote the widespread dissemination of effective treatments for PTSD. In this review, we first discuss some of the major challenges, such as a professional culture that often is antagonistic to evidence-based treatments (EBTs), a lack of clinician training in EBTs, limited effectiveness of commonly used dissemination techniques, and the significant cost associated with effective dissemination models. Next, we review local, national, and international efforts to disseminate PE and similar treatments and illustrate the challenges and successes involved in promoting the adoption of EBTs in mental health systems. We then consider ways in which the barriers discussed earlier can be overcome, as well as the difficulties involved in effecting sustained organizational change in mental health systems. We also present examples of efforts to disseminate PE in developing countries and the attendant challenges when mental health systems are severely underdeveloped. Finally, we present future directions for the dissemination of EBTs for PTSD, including the use of newer technologies such as web-based therapy and telemedicine. We conclude by discussing the need for concerted action among multiple interacting systems in order to overcome existing barriers to dissemination and promote widespread access to effective treatment for PTSD. These systems include graduate training programs, government agencies, health insurers, professional organizations, healthcare delivery systems, clinical researchers, and public education systems like the media. Each of these entities can play a major role in reducing the personal suffering and public health burden associated with posttraumatic stress.

Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety

Anxiety disorders are the most common mental health disorder among children and adolescents. We examined 111 treatment outcome studies testing 204 treatment conditions for child and adolescent anxiety published between 1967 and mid-2013. Studies were selected for inclusion in this review using the PracticeWise Evidence-Based Services database. Using guidelines identified by this journal (Southam-Gerow & Prinstein, 2014), studies were included if they were conducted with children and/or adolescents (ages 1-19) with anxiety and/or avoidance problems. In addition to reviewing the strength of the evidence, the review also examined indicators of effectiveness, common practices across treatment families, and mediators and moderators of treatment outcome. Six treatments reached well-established status for child and adolescent anxiety, 8 were identified as probably efficacious, 2 were identified as possibly efficacious, 6 treatments were deemed experimental, and 8 treatments of questionable efficacy emerged. Findings from this review suggest substantial support for cognitive-behavioral therapy (CBT) as an effective and appropriate first-line treatment for youth with anxiety disorders. Several other treatment approaches emerged as probably efficacious that are not primarily CBT based, suggesting that there are alternative evidence-based treatments that practitioners can turn to for children and adolescents who do not respond well to CBT. The review concludes with a discussion of treatments that improve functioning in addition to reducing symptoms, common practices derived from evidence-based treatments, mediators and moderators of treatment outcomes, recommendations for best practice, and suggestions for future research.

Strategies for integrating mental health into schools via a multitiered system of support

To fully realize the potential of mental health supports in academic settings, it is essential to consider how to effectively integrate the mental health and education systems and their respective resources, staffing, and structures. Historically, school mental health services have not effectively spanned a full continuum of care from mental health promotion to treatment, and several implementation and service challenges have evolved. After an overview of these challenges, best practices and strategies for school and community partners are reviewed to systematically integrate mental health interventions within a school's multitiered system of student support.

School intervention related to school and community violence

Schools are well positioned to facilitate recovery for students exposed to community or school violence or other traumatic life events affecting populations of youth. This article describes how schools can circumvent several key barriers to mental health service provision, outcomes that school interventions target, and the role of the family in school-based services. It includes a description of the history of schools in facilitating recovery for students exposed to traumatic events, particularly related to crisis intervention, and the current status of early intervention and strategies for long-term recovery in the school setting. Challenges and future directions are also discussed.

Therapists and researchers: advancing collaboration

Collaborative partnerships between community-based clinicians and academic researchers have the potential to improve the relevance, utility, and feasibility of research, as well as the effectiveness of practice. Collaborative partnership research from a variety of fields can inform the development and maintenance of effective partnerships. In this paper we present a conceptual model of research-community practice partnership derived from literature across disciplines and then illustrate application of this model to one case example. The case example is a multi-year partnership between an interdisciplinary group of community-based psychotherapists and a team of mental health researchers. This partnership was initiated to support federally funded research on community-based outpatient mental health care for children with disruptive behavior problems, but it has evolved to drive and support new intervention studies with different clinical foci. Lessons learned from this partnership process will be shared and interpreted in the context of the presented research-practice partnership model.

Creating a national home visiting research network

Home visiting can play a key role in the early childhood system of services. For home visiting to achieve its potential, decision-makers must make informed choices regarding adoption, adaptation, coordination, scale-up, and sustainment. We need a coordinated, focused, and theory-based home visiting research infrastructure to inform such decisions. The transdisciplinary Home Visiting Research Network (HVRN) was established in July 2012 with funding from the Health Resources and Services Administration. Its goal is to promote the translation of research findings into policy and practice. Its objectives are to (1) develop a national home visiting research agenda, (2) advance the use of innovative research methods; and (3) provide a research environment that is supportive of the professional development of emerging researchers interested in home visiting. A Management Team designs and directs activities to achieve these objectives through Work Teams. A Steering Committee of national leaders representing stakeholder groups oversees progress. HVRN's Coordinating Center supports the Work Teams and HVRN's Home visiting Applied Research Collaborative, a practice-based research network of home visiting programs. This article describes HVRN's rationale, approach, and anticipated products. We use home visiting-primary care coordination as an illustration, noting potential roles for pediatric practices and pediatric researchers and research educators in HVRN activities. HVRN creates the infrastructure for a rigorous program of research to inform policy and practice on home visiting as part of the system of services to improve family functioning, parenting, and child outcomes.

Anxious youth in research and service clinics

With the current focus on increasing utilization of empirically supported treatments, knowledge of sample differences and similarities has increasing importance. The present study compared anxiety-disordered youth (age 7-13) from (a) five Norwegian service clinics (SC, N = 111) to (b) a university research clinic (RC) in Philadelphia, USA (N = 144) on pre-treatment characteristics measured by the Multidimensional Anxiety Scale for Children, Child Behavior Checklist, Teacher Report Form, Anxiety Disorders Interview Schedule, and Children's Global Assessment Scale (CGAS). SC youth demonstrated higher levels of anxiety based on child- (d = 0.42-1.04) and parent-report (d = 0.53) and conduct problems based on parent-report (d = 0.43) compared to RC youth. SC youth was more functionally impaired on the CGAS (d = 0.97), whereas RC youth evidenced a greater number of diagnoses (d = 0.63). The two samples were equivalent regarding parent-reported symptoms of affective, somatic, attention-deficit/hyperactivity, and oppositional problems. Future directions and clinical implications are discussed.

Parent Perspectives on Community Mental Health Services for Children with Autism Spectrum Disorders

The community mental health (CMH) system provides treatment for behavioral and psychiatric problems in children with autism spectrum disorders (ASD). Although parent stakeholder perspectives are important to improving care, these perspectives have not been systematically examined for this population in the CMH sector. Twenty-one semi-structured qualitative interviews were conducted with parents of children with ASD who received services in CMH clinics. Themes related to child clinical histories, service access and experiences with the CMH system revealed a specific trajectory of service need identification, obtaining a diagnosis, and experience with services. Each trajectory stage was marked by high parent stress. Results provide information about the characteristics of children with ASD served in community mental health clinics and direction for targeted improvement efforts.

Combining individual cognitive behaviour therapy and caregiver-child sessions for childhood depression: an open trial

The objective was to obtain preliminary evidence on the feasibility and efficacy of combining individual cognitive behavior therapy (CBT) with complimentary caregiver-child sessions for depressed youths. Fifteen children participated in an open clinical trial. Treatment included 16 CBT sessions combined with seven caregiver/caregiver-child sessions over 12 weeks. Data were collected at pre-, mid-, and post-treatment and at one- and six-month follow-ups. Significant decreases in depressive symptoms were apparent, with the majority showing clinically meaningful improvement. Benchmarked against the literature, the combination equaled or outperformed CBT in other studies and was superior to control conditions. Mother and teacher reports of child functioning significantly improved, providing social validation of the effects. Mothers reported improved caregiver-child relationships and less parenting stress. Children did not report acute improvements in relations with their caregivers. However, when a father participated, improved father-child relations were reported in the follow-up period. Younger age and lower pretreatment severity predicted greater symptom change. The positive treatment effects provide support for the combined intervention and suggest a further research focus on the effects of caregiver involvement in the treatment of depressed youths.

Improvement in symptoms versus functioning: how do our best treatments measure up?

We examined the effects of redefining standards of evidence for treatments targeting childhood mental health problems by expanding outcomes beyond symptom reduction to include functioning. Over 750 treatment protocols from 435 randomized controlled trials were rated based on empirical evidence. Nearly two-thirds (63.9%) demonstrated at least a minimum level of evidence for reducing symptoms; however, only 18.8% of treatments demonstrated evidence for reducing functional impairment. Of those treatments with empirical support for symptom reduction, the majority did not demonstrate empirical support for improvement in functioning because measures of functioning were not included in the studies in which these treatments were tested. However, even when measures of functioning were included, it was much more difficult for treatments to achieve improvement. Among treatments that achieved improvement in functioning, the most notable were Collaborative Problem Solving for disruptive behavior and Cognitive Behavioral Therapy plus Medication for traumatic stress because they demonstrated no support for symptom reduction but good support for improvement in functioning. Results are discussed within the context of evaluating the standards of evidence for treatments and the opportunity to move towards a multidimensional framework whose utility has the potential to exceed the sum of its parts.

The effects of family therapies for adolescent delinquency and substance abuse: a meta-analysis

This meta-analysis summarizes results from k = 24 studies comparing either Brief Strategic Family Therapy, Functional Family Therapy, Multidimensional Family Therapy, or Multisystemic Therapy to either treatment-as-usual, an alternative therapy, or a control group in the treatment of adolescent substance abuse and delinquency. Additionally, the authors reviewed and applied three advanced meta-analysis methods including influence analysis, multivariate meta-analysis, and publication bias analyses. The results suggested that as a group the four family therapies had statistically significant, but modest effects as compared to treatment-as-usual (d = 0.21; k = 11) and as compared to alternative therapies (d = 0.26; k = 11). The effect of family therapy compared to control was larger (d = 0.70; k = 4) but was not statistically significant probably because of low power. There was insufficient evidence to determine whether the various models differed in their effectiveness relative to each other. Influence analyses suggested that three studies had a large effect on aggregate effect sizes and heterogeneity statistics. Moderator and multivariate analyses were largely underpowered but will be useful as this literature grows.

Characteristics of anxious and depressed youth seen in two different clinical contexts

Previous research has revealed that youth seen at community clinics present with a higher frequency of externalizing problems and are demographically different from youth seen at research clinics. This study extends findings on these discrepancies by examining differences between youth at research and community clinics meeting criteria for two different primary disorders (anxiety and depression). Consistent with prior research, community clinic youth reported lower incomes, were more ethnically diverse, and had higher rates of externalizing problems compared to research clinic youth, regardless of primary diagnosis. Findings are discussed in terms of enhancing dissemination of evidence-based treatments for internalizing disorders in community settings.

The efficacy of a Social Skills Group Intervention for improving social behaviors in children with High Functioning Autism Spectrum disorders

This study tested the efficacy of a new social skills intervention, S ocial S kills GR oup IN tervention-High Functioning Autism (S.S.GRIN-HFA), designed to improve social behaviors in children with high functioning autism spectrum disorders. Fifty-five children were randomly assigned to S.S.GRIN-HFA treatment (n = 27) or control (i.e., traditional S.S.GRIN intervention; n = 28). Examination of the direction and magnitude of change in functioning revealed that children who participated in S.S.GRIN-HFA exhibited significantly greater mastery of social skill concepts compared to children in the control group. Parents of S.S.GRIN-HFA group participants reported an improved sense of social self-efficacy, whereas parents of control participants reported a decline. The advantages of a specialized intervention such as S.S.GRIN-HFA, designed specifically for children with high functioning autism spectrum disorders, are discussed.

Psychosocial issues for children with epilepsy

Epilepsy is a pervasive disorder that consists not only of seizures, but of behavioral, academic, and social difficulties. Epilepsy has an impact on the entire family and may have a significant effect on the interrelationships between child and parent. Epilepsy also has a potentially deleterious effect on academic functioning that may be the result of central nervous system dysfunction, seizures, antiepileptic drugs, or child and family response to illness. Early assessment for psychosocial problems and appropriate interventions can be beneficial for the child and family. Particular attention should be paid to periods of transition such as the move from adolescence to adulthood.

Evidence-based practices and autism

Interventions for autism are increasing being held to standards such as 'evidence-based practice' in psychology and 'scientifically-based research' in education. When these concepts emerged in the context of adult psychotherapy and regular education, they caused considerable controversy. Application of the concepts to autism treatments and special education has raised additional concerns. An analysis of the benefits and limitations of current approaches to empiricism in autism interventions is presented, and suggestions for future research are made.

Eye movement desensitization and reprocessing in an adolescent with epilepsy and mild intellectual disability

Intellectual disability is a comorbid condition in epilepsy. People with epilepsy and intellectual disability are at high risk of developing behavioral problems. Among the many contributors to behavioral problems in people with epilepsy and intellectual disability are those of traumatic experiences. As such, behavioral problems can be seen as a reflection of these traumatic experiences. Among established trauma therapies, eye movement desensitization and reprocessing (EMDR) is an emerging treatment that is effective in adults and also seems to be effective in children. This article is a case report of EMDR in an adolescent with epilepsy and mild intellectual disability, in whom the EMDR children's protocol was used. The aim was to assess whether clinical trauma status significantly diminished to nonclinical status posttreatment. Change in trauma symptoms was evaluated with the Reliable Change Index (RCI). Results showed a significant decrease in trauma symptoms toward nonclinical status from pretreatment to posttreatment. EMDR consequences for epilepsy and intellectual disability are discussed.

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.

Implementation of evidence-based services for youth: assessing provider knowledge

Although provider knowledge is a potential barrier in the dissemination of evidence-based services for youth, research in this area is currently limited by a lack of instrumentation. The present study examined the utility of the Knowledge of Evidence-Based Services Questionnaire (KEBSQ), a 40-item self-report measure designed to assess reporter knowledge of evidence-based practices (EBPs) in the treatment of youth psychopathology. The KEBSQ items encompass practice elements identified in both empirically supported and unsupported protocols used in the treatment of four prevalent childhood problem areas: anxious/avoidant, depressed/withdrawn, disruptive behavior, and attention/hyperactivity. Findings from the present investigation lend support for the basic psychometric properties of the KEBSQ. Results supported temporal stability, discriminative validity, and sensitivity to training. Practical implications to the dissemination of EBPs, areas for future research, and limitations are discussed.

Adapting evidence-based mental health treatments in community settings: preliminary results from a partnership approach

This article describes the application of a university-community partnership model to the problem of adapting evidence-based treatment approaches in a community mental health setting. Background on partnership research is presented, with consideration of methodological and practical issues related to this kind of research. Then, a rationale for using partnerships as a basis for conducting mental health treatment research is presented. Finally, an ongoing partnership research project concerned with the adaptation of evidence-based mental health treatments for childhood internalizing problems in community settings is presented, with preliminary results of the ongoing effort discussed.

Increasing abused children's access to evidence-based treatment: diffusion via parents as consumers

This investigation evaluated an experimental protocol employed by nurses with parents to increase access to evidence-based mental health treatment for children who are suspected victims of abuse. The protocol was compared with typical services during forensic medical examinations, first in a quasi-experimental design, then as a randomized controlled trial. In both studies, the protocol produced a significant increase in parental reports of having discussed evidence-based treatment during a mental health appointment within 1 month after the forensic medical examination. Likewise, both studies showed that the protocol produced a significant increase in parent-reported satisfaction with the forensic medical examination. Similarly, nurses viewed the protocol favorably. These findings suggest that this approach may be sustainable as a standard component of forensic medical examinations for children who are suspected victims of abuse.

Cognitive behavioral therapy for symptoms of trauma and traumatic grief in refugee youth

The diverse clinical presentation of refugee children and adolescents after their traumatic experiences requires a treatment model that can mitigate a number of internalizing and externalizing symptoms. Refugee populations also require interventions that can adjust to the wide-ranging experiences likely encountered during preflight, flight, and resettlement. There is some evidence that immigration stressors or social stressors, such as discrimination, are associated with symptoms of posttraumatic stress disorder in refugee youth. Therefore refugee youth may benefit from multiple levels of services, ideally integrated. This article focuses on the mental and behavioral health component of services for refugee youth.

Wenn man sich schon in die Praxis begibt …

Zusammenfassung. Dreisörner (2006) vergleicht zwei Behandlungsmaßnahmen (THOP von Döpfner et al., 1998 ; Aufmerksamkeitstraining nach Lauth & Schlottke, 2002 ) für hyperkinetische Kinder unter Praxisbedingungen. Es soll herausgefunden werden, ob die Programme unter suboptimalen Bedingungen wirksam sind. Dieser Versuch schlägt aus mehreren Gründen fehl. Die Behandlung wird beim Aufmerksamkeitstraining nicht den verbindlichen Vorgaben des Programms entsprechend durchgeführt, eine Zufallszuweisung zu beiden Versuchsbedingungen ist nicht gegeben, die Behandlungserfolge beim THOP sind durch massive Einflüsse einer Pharmakotherapie mitbedingt. Das Design genügt nicht den Ansprüchen an den Praxistest, den der Autor vornehmen will. Vorschläge für eine angemessenere Evaluation erfolgen.

Degrees of freedom and degrees of certainty: a developmental model for the establishment of evidence-based youth care

There are many psychosocial interventions for children and adolescents. The effects of these interventions in day-to-day practice are nevertheless often unclear. Researchers typically take the randomized controlled trial (RCT) as the "gold standard" for the supply of evidence regarding the effectiveness of an intervention. However, such trials are rarely performed in youth care practice because they are difficult to conduct and sometimes meet with ethical objections. RCTs may also be prematurely and thus unnecessarily conducted on interventions that are not yet fully developed or interventions that have yet to be accepted into actual practice. In this article, a four-stage model for the classification and development of effective interventions carried out in actual youth care practice is presented. Stage 1 (potential interventions) requires specification of the core elements of an intervention (e.g., objectives, target groups, activities) and may involve both descriptive and implementation studies. Stage 2 (plausible interventions) requires the explication of an underlying intervention theory (e.g., what works with whom and why) and may involve both literature reviews and techniques to elicit the knowledge of experts. Stage 3 (functional interventions) requires preliminary evidence that the intervention works in actual practice and may involve client satisfaction studies, goal attainment studies, pre-post test studies, quality control studies, benchmark studies, correlational studies, and quasi-experimental studies. Stage 4 (efficacious interventions) requires clear evidence that the intervention is responsible for the observed effects and may involve RCTs and well-designed repeated case studies.