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Higa-McMillan CK, Park AL, Daleiden EL, Becker KD, Bernstein A, Chorpita BF. Getting More Out of Clinical Documentation: Can Clinical Dashboards Yield Clinically Useful Information? Adm Policy Ment Health 2024; 51:268-285. [PMID: 38261119 DOI: 10.1007/s10488-023-01329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/24/2024]
Abstract
This study investigated coded data retrieved from clinical dashboards, which are decision-support tools that include a graphical display of clinical progress and clinical activities. Data were extracted from clinical dashboards representing 256 youth (M age = 11.9) from 128 practitioners who were trained in the Managing and Adapting Practice (MAP) system (Chorpita & Daleiden in BF Chorpita EL Daleiden 2014 Structuring the collaboration of science and service in pursuit of a shared vision. 43(2):323 338. 2014, Chorpita & Daleiden in BF Chorpita EL Daleiden 2018 Coordinated strategic action: Aspiring to wisdom in mental health service systems. 25(4):e12264. 2018) in 55 agencies across 5 regional mental health systems. Practitioners labeled up to 35 fields (i.e., descriptions of clinical activities), with the options of drawing from a controlled vocabulary or writing in a client-specific activity. Practitioners then noted when certain activities occurred during the episode of care. Fields from the extracted data were coded and reliability was assessed for Field Type, Practice Element Type, Target Area, and Audience (e.g., Caregiver Psychoeducation: Anxiety would be coded as Field Type = Practice Element; Practice Element Type = Psychoeducation; Target Area = Anxiety; Audience = Caregiver). Coders demonstrated moderate to almost perfect interrater reliability. On average, practitioners recorded two activities per session, and clients had 10 unique activities across all their sessions. Results from multilevel models showed that clinical activity characteristics and sessions accounted for the most variance in the occurrence, recurrence, and co-occurrence of clinical activities, with relatively less variance accounted for by practitioners, clients, and regional systems. Findings are consistent with patterns of practice reported in other studies and suggest that clinical dashboards may be a useful source of clinical information. More generally, the use of a controlled vocabulary for clinical activities appears to increase the retrievability and actionability of healthcare information and thus sets the stage for advancing the utility of clinical documentation.
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Crane ME, Kendall PC, Chorpita BF, Sanders MR, Miller AR, Webster-Stratton C, McWilliam J, Beck JS, Ashen C, Embry DD, Pickering JA, Daleiden EL. The role of implementation organizations in scaling evidence-based psychosocial interventions. Implement Sci 2023; 18:24. [PMID: 37349845 PMCID: PMC10288683 DOI: 10.1186/s13012-023-01280-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND To bring evidence-based interventions (EBIs) to individuals with behavioral health needs, psychosocial interventions must be delivered at scale. Despite an increasing effort to implement effective treatments in communities, most individuals with mental health and behavioral problems do not receive EBIs. We posit that organizations that commercialize EBIs play an important role in disseminating EBIs, particularly in the USA. The behavioral health and implementation industry is growing, bringing the implementation field to an important inflection point: how to scale interventions to improve access while maintaining EBI effectiveness and minimizing inequities in access to psychosocial intervention. MAIN BODY We offer a first-hand examination of five illustrative organizations specializing in EBI implementation: Beck Institute for Cognitive Behavioral Therapy; Incredible Years, Inc.; the PAXIS Institute; PracticeWise, LLC; and Triple P International. We use the Five Stages of Small Business Growth framework to organize themes. We discuss practical structures (e.g., corporate structures, intellectual property agreements, and business models) and considerations that arise when trying to scale EBIs including balancing fidelity and reach of the intervention. Business models consider who will pay for EBI implementation and allow organizations to scale EBIs. CONCLUSION We propose research questions to guide scaling: understanding the level of fidelity needed to maintain efficacy, optimizing training outcomes, and researching business models to enable organizations to scale EBIs.
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Affiliation(s)
- Margaret E Crane
- Department of Psychology, Temple University, Weiss Hall, 1701 N 13th St, Philadelphia, PA, 19122, USA.
- Department of Psychiatry, New York Presbyterian-Weill Cornell Medicine, 425 E 61st St, New York, NY, 10065, USA.
| | - Philip C Kendall
- Department of Psychology, Temple University, Weiss Hall, 1701 N 13th St, Philadelphia, PA, 19122, USA.
| | - Bruce F Chorpita
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA
- PracticeWise, LLC, 410 Coach Rd, Satellite Beach, FL, 32937, USA
| | - Matthew R Sanders
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, St Lucia, QLD, 4067, Australia
| | - Allen R Miller
- Beck Institute for Cognitive Behavior Therapy, 1 Belmont Ave #700, Bala Cynwyd, PA, 19004, USA
| | | | - Jenna McWilliam
- Triple P International, 11 Market St N, Indooroopilly, QLD, 4068, Australia
| | - Judith S Beck
- Beck Institute for Cognitive Behavior Therapy, 1 Belmont Ave #700, Bala Cynwyd, PA, 19004, USA
| | - Ceth Ashen
- C. Ashen Consulting, 222 North Canon Dr. Ste 205, Beverly Hills, CA, 90210, USA
| | | | | | - Eric L Daleiden
- PracticeWise, LLC, 410 Coach Rd, Satellite Beach, FL, 32937, USA
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Cheron DM, Becker-Haimes EM, Stern HG, Dwight AR, Stanick CF, Chiu AW, Daleiden EL, Chorpita BF. Assessing practical implementation of modular psychotherapy for youth in community-based settings using benchmarking. Implementation Research and Practice 2022; 3:26334895221115216. [PMID: 37091107 PMCID: PMC9924269 DOI: 10.1177/26334895221115216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Achieving high quality outcomes in a community context requires the strategic coordination of many activities in a service system, involving families, clinicians, supervisors, and administrators. In modern implementation trials, the therapy itself is guided by a treatment manual; however, structured supports for other parts of the service system may remain less well-articulated (e.g., supervision, administrative policies for planning and review, information/feedback flow, resource availability). This implementation trial investigated how a psychosocial intervention performed when those non-therapy supports were not structured by a research team, but were instead provided as part of a scalable industrial implementation, testing whether outcomes achieved would meet benchmarks from published research trials. Method In this single-arm observational benchmarking study, a total of 59 community clinicians were trained in the Modular Approach to Therapy for Children (MATCH) treatment program. These clinicians delivered MATCH treatment to 166 youth ages 6 to 17 naturally presenting for psychotherapy services. Clinicians received substantially fewer supports from the treatment developers or research team than in the original MATCH trials and instead relied on explicit process management tools to facilitate implementation. Prior RCTs of MATCH were used to benchmark the results of the current initiative. Client improvement was assessed using the Top Problems Assessment and Brief Problem Monitor. Results Analysis of client symptom change indicated that youth experienced improvement equal to or better than the experimental condition in published research trials. Similarly, caregiver-reported outcomes were generally comparable to those in published trials. Conclusions Although results must be interpreted cautiously, they support the feasibility of using process management tools to facilitate the successful implementation of MATCH outside the context of a formal research or funded implementation trial. Further, these results illustrate the value of benchmarking as a method to evaluation industrial implementation efforts. Plain Language Summary: Randomized effectiveness trials are inclusive of clinicians and cases that are routinely encountered in community-based settings, while continuing to rely on the research team for both clinical and administrative guidance. As a result, the field still struggles to understand what might be needed to support sustainable implementation and how interventions will perform when brought to scale in community settings without those clinical trial supports. Alternative approaches are needed to delineate and provide the clinical and operational support needed for implementation and to efficiently evaluate how evidence-based treatments perform. Benchmarking findings in the community against findings of more rigorous clinical trials is one such approach. This paper offers two main contributions to the literature. First, it provides an example of how benchmarking is used to evaluate how the Modular Approach to Therapy for Children (MATCH) treatment program performed outside the context of a research trial. Second, this study demonstrates that MATCH produced comparable symptom improvements to those seen in the original research trials and describes the implementation strategies associated with this success. In particular, although clinicians in this study had less rigorous expert clinical supervision as compared with the original trials, clinicians were provided with process management tools to support implementation. This study highlights the importance of evaluating the performance of intervention programs when brought to scale in community-based settings. This study also provides support for the use of process management tools to assist providers in effective implementation.
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Affiliation(s)
- Daniel M. Cheron
- Vice President of Clinical Programs, Implementation, & Training, Judge Baker Children’s Center, Boston, Massachusetts, USA
| | | | | | | | - Cameo F. Stanick
- Vice President of Clinical Practice, Training, and Research and Evaluation, Hathaway-Sycamores Child and Family Services, Pasadena, California, USA
| | - Angela W. Chiu
- Assistant Professor of Psychology in Clinical Psychiatry, Weill Cornell Medicine, New York, New York, USA
| | | | - Bruce F. Chorpita
- Professor of Psychology, The University of California, Los Angeles, Los Angeles, California, USA
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Becker KD, Daleiden EL, Kataoka SH, Edwards SM, Best KM, Donohue A, Chorpita BF. Pilot Study of the MAP Curriculum for Psychotherapy Competencies in Child and Adolescent Psychiatry. Am J Psychother 2021; 75:82-88. [PMID: 34724809 DOI: 10.1176/appi.psychotherapy.20210010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This pilot study aimed to evaluate the relevance, feasibility, acceptability, and instructional efficacy of the Managing and Adapting Practice (MAP) curriculum for enhancing the teaching of psychotherapy to child and adolescent psychiatry (CAP) fellows. MAP is a system of resources and decision models that supports practitioners in selecting and implementing psychotherapeutic interventions for children and adolescents. The MAP curriculum includes modules to guide education about psychotherapeutic procedures (e.g., behavioral activation) common in evidence-based treatments for an array of childhood problems and to support development of competencies in assessment, treatment planning, and reflective practice. METHODS Curriculum coding was used to examine the relevance of MAP's core components to the skills articulated in the Accreditation Council for Graduate Medical Education (ACGME) CAP milestones. Feasibility, acceptability, and learning outcomes were examined after delivery of the MAP curriculum to 12 CAP fellows at two sites, with instructional features tailored according to faculty preferences and training program structure. RESULTS Coding suggested that the MAP curriculum was relevant to 95% of the 21 ACGME CAP training subcompetencies. Feasibility was indicated by the successful delivery of 100% of the planned MAP curriculum across the two sites. Acceptability was supported by positive feedback from the CAP fellows, and psychotherapy knowledge increased significantly. Finally, case review scores (mean±SD=2.21±0.15) showed positive posttraining application of MAP to two patients and exceeded scores achieved by other samples of mental health professionals. CONCLUSIONS This pilot study demonstrated the potential for the MAP curriculum to support CAP education. MAP's versatility as a curriculum supports broader adoption, with continuing rigorous empirical evaluation.
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Affiliation(s)
- Kimberly D Becker
- Department of Psychology, University of South Carolina, Columbia (Becker); PracticeWise, Satellite Beach, Florida (Daleiden); Department of Psychiatry and Biobehavioral Sciences, and Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles (Kataoka, Best); Department of Psychiatry, University of Maryland, Baltimore (Edwards, Donohue); Department of Psychology, University of California, Los Angeles (Chorpita)
| | - Eric L Daleiden
- Department of Psychology, University of South Carolina, Columbia (Becker); PracticeWise, Satellite Beach, Florida (Daleiden); Department of Psychiatry and Biobehavioral Sciences, and Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles (Kataoka, Best); Department of Psychiatry, University of Maryland, Baltimore (Edwards, Donohue); Department of Psychology, University of California, Los Angeles (Chorpita)
| | - Sheryl H Kataoka
- Department of Psychology, University of South Carolina, Columbia (Becker); PracticeWise, Satellite Beach, Florida (Daleiden); Department of Psychiatry and Biobehavioral Sciences, and Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles (Kataoka, Best); Department of Psychiatry, University of Maryland, Baltimore (Edwards, Donohue); Department of Psychology, University of California, Los Angeles (Chorpita)
| | - Sarah M Edwards
- Department of Psychology, University of South Carolina, Columbia (Becker); PracticeWise, Satellite Beach, Florida (Daleiden); Department of Psychiatry and Biobehavioral Sciences, and Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles (Kataoka, Best); Department of Psychiatry, University of Maryland, Baltimore (Edwards, Donohue); Department of Psychology, University of California, Los Angeles (Chorpita)
| | - Karin M Best
- Department of Psychology, University of South Carolina, Columbia (Becker); PracticeWise, Satellite Beach, Florida (Daleiden); Department of Psychiatry and Biobehavioral Sciences, and Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles (Kataoka, Best); Department of Psychiatry, University of Maryland, Baltimore (Edwards, Donohue); Department of Psychology, University of California, Los Angeles (Chorpita)
| | - April Donohue
- Department of Psychology, University of South Carolina, Columbia (Becker); PracticeWise, Satellite Beach, Florida (Daleiden); Department of Psychiatry and Biobehavioral Sciences, and Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles (Kataoka, Best); Department of Psychiatry, University of Maryland, Baltimore (Edwards, Donohue); Department of Psychology, University of California, Los Angeles (Chorpita)
| | - Bruce F Chorpita
- Department of Psychology, University of South Carolina, Columbia (Becker); PracticeWise, Satellite Beach, Florida (Daleiden); Department of Psychiatry and Biobehavioral Sciences, and Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles (Kataoka, Best); Department of Psychiatry, University of Maryland, Baltimore (Edwards, Donohue); Department of Psychology, University of California, Los Angeles (Chorpita)
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Bentovim A, Chorpita BF, Daleiden EL, Gray J, Pizzey S, Vizard E. The value of a modular, multi-focal, therapeutic approach to addressing child maltreatment: Hope for Children and Families Intervention Resources - a discussion article. Child Abuse Negl 2021; 119:104703. [PMID: 32951866 DOI: 10.1016/j.chiabu.2020.104703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/13/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
This discussion article begins by highlighting two trends apparent in the field of child maltreatment. The first, an awareness that multiple forms of maltreatment - polyvictimization - is the rule in populations of abused and neglected children rather than the exception. The second is that current types of child maltreatment are being extended to include Adverse Childhood Experiences (ACEs). These include intra-familial violence, mental health, substance misuse, and inter-generational abuse. The paper introduces an innovative strategy to help the field better organise and prevent the extensive sequelae of polyvictimization and ACEs. This strategy involves the development of a modular approach, which identifies common treatment elements and common factors across the field of effective interventions and organizes them, providing a co-ordinated framework for practitioners to use to address the diverse needs of children and families when vulnerability or maltreatment are identified. The development of this approach, the Hope for Children and Families (HfCF) Intervention Resources, is described using a case example to illustrate its logic and structure. Findings from the HFCF pilot and subsequent training programs suggest that this new approach could be an important milestone in the protection of children from violence, abuse and neglect on the 30th Anniversary of the United Nation's Convention on the Rights of the Child (1989).
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Affiliation(s)
- Arnon Bentovim
- Child and Family Training, PO Box 723, York, Y030 7WS, UK; Royal Holloway University of London School of Biological Sciences, Egham, Surrey, UK.
| | - Bruce F Chorpita
- Department of Psychology, University of California, Box 951563, Los Angeles, CA, 90095, USA.
| | - Eric L Daleiden
- PracticeWise, LLC, 340 Lee Ave Satellite Beach, FL, 32937, USA.
| | - Jenny Gray
- Child and Family Training UK, PO Box 723, York, Y030 7WS, UK; UCL Great Ormond Street Institute of Child Health, 30 Guilford St, London, WC1N 1EH, UK.
| | - Stephen Pizzey
- Child and Family Training UK, PO Box 723, York, Y030 7WS, UK.
| | - Eileen Vizard
- UCL Great Ormond Street Institute of Child Health, 30 Guilford St, London, WC1N 1EH, UK; New York University in London, London, UK.
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Chorpita BF, Daleiden EL, Vera JD, Guan K. Creating a prepared mental health workforce: comparative illustrations of implementation strategies. Evid Based Ment Health 2021; 24:5-10. [PMID: 33355251 PMCID: PMC10231619 DOI: 10.1136/ebmental-2020-300203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Psychotherapy implementation must contend with the task of preparing a mental health workforce to provide the highest quality services to as much of a service population as possible, in high-income as well as low-to-middle income countries. OBJECTIVE We outline general challenges and solutions and investigate how well various implementation strategies would fit a clinical population. METHODS Using a data set from a prior cluster randomised trial with a clinically diverse population and 33 intervention practices, we presented multiple illustrations comparing the ability of different implementation strategies to serve youth and families with procedures in which service providers were trained. FINDINGS A series of survival functions demonstrated that many common implementation strategies are unlikely to create a prepared workforce, given the large and diverse number of practices needed to be mastered by providers. CLINICAL IMPLICATIONS 'Benchmark' solutions that afforded superior coverage of the service population could be supported through paced learning approaches (ie, training interventions a little at a time) using extensible, modular intervention designs.
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Chorpita BF, Daleiden EL, Malik K, Gellatly R, Boustani MM, Michelson D, Knudsen K, Mathur S, Patel VH. Design process and protocol description for a multi-problem mental health intervention within a stepped care approach for adolescents in India. Behav Res Ther 2020; 133:103698. [PMID: 32858304 DOI: 10.1016/j.brat.2020.103698] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/30/2020] [Accepted: 07/27/2020] [Indexed: 01/18/2023]
Abstract
This paper documents the collaborative design of a mental health intervention for adolescents in India with anxiety, depression, or anger-related concerns. The process was characterized by three phases of formative activities: (1) an intensive review of the service context, (2) selection of an overall design strategy (e.g., whether to choose existing evidence-based treatments or build new treatments in context), and (3) a period of prototyping, testing, and refining. Each phase resulted in specific outputs, which were, respectively, (1) a detailed articulation of values and preferences (setting expectations for what the ideal protocol should be), (2) a set of build parameters representing a blueprint that managed strategic compromises for this context, and (3) a working protocol. We outline the steps of this design process, summarize data from an open-trial clinical case series, and illustrate the resulting working protocol, which will be tested in a future larger trial. We conclude with insights and observations likely to be relevant to protocol design activity in a variety of contexts, most particularly those in low-and-middle-income countries such as India.
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Affiliation(s)
- Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, USA.
| | | | | | - Resham Gellatly
- Department of Psychology, University of California, Los Angeles, USA
| | | | | | - Kendra Knudsen
- Department of Psychology, University of California, Los Angeles, USA
| | | | - Vikram H Patel
- Department of Global Health and Social Medicine, Harvard Medical School, USA
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Cheron DM, Chiu AAW, Stanick CF, Stern HG, Donaldson AR, Daleiden EL, Chorpita BF. Implementing Evidence Based Practices for Children's Mental Health: A Case Study in Implementing Modular Treatments in Community Mental Health. Adm Policy Ment Health 2020; 46:391-410. [PMID: 30710173 DOI: 10.1007/s10488-019-00922-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
There is strong enthusiasm for utilizing implementation science in the implementation of evidence-based programs in children's community mental health, but there remains work to be done to improve the process. Despite the proliferation of implementation frameworks, there is limited literature providing case examples of overcoming implementation barriers. This article examines whether the use of three implementations strategies, a structured training and coaching program, the use of professional development portfolios for coaching, and a progress monitoring data system, help to overcome barriers to implementation by facilitating four implementation drivers at a community mental health agency. Results suggest that implementation is a process of recognizing and adapting to both predictable and unpredictable barriers. Furthermore, the use of these implementation strategies is important in improving implementation outcomes.
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Affiliation(s)
- Daniel M Cheron
- Judge Baker Children's Center, 53 Parker Hill Avenue, Boston, MA, 02120, USA.
| | | | | | - H Gemma Stern
- Judge Baker Children's Center, 53 Parker Hill Avenue, Boston, MA, 02120, USA
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Westman JG, Daleiden EL, Chorpita BF. The agency supervisor model: developing supervisors who facilitate therapist transfer of training in community behavioral health service organizations. The Clinical Supervisor 2019. [DOI: 10.1080/07325223.2019.1695159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jonathan G. Westman
- Department of Psychology, University of California, Los Angeles, California, USA
| | | | - Bruce F. Chorpita
- Department of Psychology, University of California, Los Angeles, California, USA
- PracticeWise, LLC., Satellite Beach, Florida, USA
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Higa-McMillan C, Kotte A, Jackson D, Daleiden EL. Overlapping and Non-overlapping Practices in Usual and Evidence-Based Care for Youth Anxiety. J Behav Health Serv Res 2018; 44:684-694. [PMID: 26945583 DOI: 10.1007/s11414-016-9502-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study compared consistencies and discrepancies in usual care with practices derived from the evidence-base (PDEB) for youth anxiety in a public mental health system. Youth-level factors (diagnosis, functional impairment) as predictors of the discrepancies were also examined. Psychosocial and service data from 2485 youth with an anxiety disorder and/or receiving services for an anxiety treatment target were extracted. Therapists (N = 616) identified the treatment targets and practices youth received. Although many PDEB for youth anxiety were used by therapists in this sample, Exposure was only used in 15% of cases. Practices not consistent with youth anxiety treatment were also reported and included: PDEB for other conditions, practices common to all therapies, and practices that are not consistent with evidence-based care. Age and diagnosis predicted the delivery of PDEB for youth anxiety. Usual care incorporated many components of evidence-based care but was more diffuse and less focused on well-supported practices.
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Affiliation(s)
| | - Amelia Kotte
- University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - David Jackson
- University of Hawai'i at Mānoa, Honolulu, HI, USA.,Hawai'i Department of Health, Child and Adolescent Mental Health Division, Honolulu, HI, USA
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Higa-McMillan CK, Nakamura BJ, Becker KD, Chang JP, Chiu A, Stanick CF, Cheron DM, Daleiden EL, Chorpita BF. Measuring practice element procedural knowledge: How do trainees PERForm? Training and Education in Professional Psychology 2017. [DOI: 10.1037/tep0000160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chorpita BF, Daleiden EL, Park AL, Ward AM, Levy MC, Cromley T, Chiu AW, Letamendi AM, Tsai KH, Krull JL. Child STEPs in California: A cluster randomized effectiveness trial comparing modular treatment with community implemented treatment for youth with anxiety, depression, conduct problems, or traumatic stress. J Consult Clin Psychol 2017; 85:13-25. [DOI: 10.1037/ccp0000133] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rith-Najarian LR, Daleiden EL, Chorpita BF. Evidence-Based Decision Making in Youth Mental Health Prevention. Am J Prev Med 2016; 51:S132-9. [PMID: 27378254 DOI: 10.1016/j.amepre.2016.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 05/05/2016] [Accepted: 05/19/2016] [Indexed: 11/28/2022]
Abstract
Given the impressive amount of knowledge relevant to prevention efforts, this paper articulates strategies to capitalize on such knowledge through evidence-based decision making. Knowledge, or "evidence," is understood here as coming from multiple sources, including research, individual people, group history, and relevant theory. The presented strategies to facilitate evidence-based decision making are: (1) intervention knowledge management; (2) collaborative design; (3) knowledge resources for intervention; and (4) developmentally sensitive training and supervision. Examples and benefits are outlined for each strategy. It is ultimately argued that evidence-based decision making embodies the scientific approach, and is worth consideration within primary prevention, given its early success in secondary intervention of youth mental health.
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Affiliation(s)
- Leslie R Rith-Najarian
- Department of Psychology, University of California, Los Angeles, Los Angeles, California.
| | | | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, Los Angeles, California; PracticeWise, LLC, Satellite Beach, Florida
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Chorpita BF, Rotheram-Borus MJ, Daleiden EL, Bernstein A, Cromley T, Swendeman D, Regan J. The Old Solutions Are the New Problem: How Do We Better Use What We Already Know About Reducing the Burden of Mental Illness? Perspect Psychol Sci 2015; 6:493-7. [PMID: 25580154 DOI: 10.1177/1745691611418240] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Kazdin and Blase (2011) propose that traditional models of delivering therapy require more resources than are available to address the scope of mental illness. We argue that finding new platforms and avenues for our existing treatments is a good start but that it is not enough. We contend that the field also needs to develop formal strategies to reorganize its increasing abundance of knowledge to address the scarcity of resources for its application. If we can better utilize our existing knowledge, treatment delivery and service resource allocation can become more efficient and effective. If the field continues with its almost singular emphasis on knowledge proliferation (e.g., developing new treatments), as opposed to knowledge management (e.g., developing new ways to design, apply, and organize existing treatments), the problem outlined by Kazdin and Blase cannot be solved.
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Affiliation(s)
| | | | | | - Adam Bernstein
- Department of Psychology, University of California, Los Angeles
| | - Taya Cromley
- Department of Psychology, University of California, Los Angeles
| | | | - Jennifer Regan
- Department of Psychology, University of California, Los Angeles
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Bernstein A, Chorpita BF, Daleiden EL, Ebesutani CK, Rosenblatt A. Building an evidence-informed service array: Considering evidence-based programs as well as their practice elements. J Consult Clin Psychol 2015; 83:1085-96. [PMID: 26030761 DOI: 10.1037/ccp0000029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study empirically examined options for building an evidence-informed service array, comparing strategies to maximize the application of evidence-based treatment literature in a clinical service system. The overall goal was to determine the smallest set of treatments that could serve the largest percentage of clients. Solutions to this problem differ depending on how one defines "treatment." METHOD Treatments were conceptualized as (a) programs (integrated treatments produced by specific research laboratories or investigators), and (b) collections of their constituent common procedures, referred to as practice elements. Programs listed by 2 separate government-sanctioned registries were selected to illustrate the effects of "program" conceptualizations, and all available clinical trials testing the programs were analyzed. Practice elements were identified from these same studies and from studies of other treatments that met a standard of evidence but had not been organized into programs on these lists. Relevance mapping methodology was used to identify optimal sets of programs and practice elements. RESULTS Among a large, diverse clinical population, results identified 11%-22% of youths for whom practice elements provide an evidence-informed treatment option whereas no programs meeting the standard of evidence were available on the registries. Results for the practice elements were able to be matched by a hybrid combination: "best" programs, which were then extended by practice elements. CONCLUSIONS These results demonstrated that there are multiple ways to conceptualize treatments when planning a service array, and these options have significant implications regarding who can be served by treatments supported by evidence.
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Affiliation(s)
| | | | | | | | - Abram Rosenblatt
- Department of Psychiatry, University of California, San Francisco
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Becker KD, Chorpita BF, Daleiden EL. Coordinating people and knowledge: Efficiency in the context of the Patient Protection and Affordable Care Act. Clinical Psychology: Science and Practice 2014. [DOI: 10.1111/cpsp.12062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
This article introduces a special issue that provides an overarching conceptual model for advancing the impact of science on service delivery and includes some illustrations of these concepts in action from a variety of research teams in a diversity of contexts. Themes of the special issue include balancing considerations of efficacy, effectiveness, and extensiveness--for example, ensuring that treatments are not only reliable but also robust and widely relevant. It is argued that such a balance might be achieved through an increased focus on improving coordination of system resources (e.g., clients, providers, treatments, training programs) and through dynamic and developmental designs. The special issue is intended to raise the broader question of whether our current paradigms are satisfactory in moving us toward our shared vision, or whether we could do more with what we already know.
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Affiliation(s)
- Bruce F Chorpita
- a Department of Psychology , University of California , Los Angeles
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Southam-Gerow MA, Daleiden EL, Chorpita BF, Bae C, Mitchell C, Faye M, Alba M. MAPping Los Angeles County: taking an evidence-informed model of mental health care to scale. J Clin Child Adolesc Psychol 2013; 43:190-200. [PMID: 24079613 DOI: 10.1080/15374416.2013.833098] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We describe the scaling up of an evidence-informed model of care, Managing and Adapting Practice (MAP) in Los Angeles County, California. MAP complemented an array of evidence-based programs selected by the county as part of a large system reform effort designed to improve care for children and adolescents. In addition, we discuss the MAP model for training therapists and present data both on how the training model performed and on the outcomes of youths treated by therapists trained in MAP. We examined the success of two different training pathways for MAP therapists: (a) national training model and (b) MAP agency supervisor model (i.e., train the trainer). We also examined utilization of MAP and outcomes of clients served by MAP. Both the national training and MAP agency supervisor model were successful in producing MAP therapists in a timely fashion and with acceptable competency scores. Furthermore, a large number of clients were receiving MAP services. Finally, outcomes for youth treated with MAP were strong, with effect sizes ranging from .59 to .80 on the Youth Outcome Questionnaire. These data support the notion that scaling up a mental health services approach in a system can be achieved through a strong and broad partnership among relevant stakeholders, can involve a train-the-trainer model, and can result in strong outcomes for clients.
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Bernstein A, Chorpita BF, Rosenblatt A, Becker KD, Daleiden EL, Ebesutani CK. Fit of Evidence-Based Treatment Components to Youths Served by Wraparound Process: A Relevance Mapping Analysis. Journal of Clinical Child & Adolescent Psychology 2013; 44:44-57. [DOI: 10.1080/15374416.2013.828296] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | - Abram Rosenblatt
- c Department of Psychiatry , University of California, San Francisco and EMQ FamiliesFirst
| | - Kimberly D. Becker
- d Division of Child & Adolescent Psychiatry , University of Maryland School of Medicine
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Abstract
The enduring needs of our society highlight the importance of a shared vision to improve human functioning and yield better lives for families and communities. Science offers a powerful strategy for managing the inevitable uncertainty in pursuit of these goals. This article presents ideas and examples of methods that could preserve the strengths of the two major paradigms in children's mental health, evidence-based treatments and individualized care models, but that also have the potential to extend their applicability and impact. As exemplified in some of the articles throughout this issue, new models to connect science and service will likely emerge from novel consideration of better ways to structure and inform collaboration within mental health systems. We contend that the future models for effective systems will involve increased attention to (a) client and provider developmental pathways, (b) explicit frameworks for coordinating people and the knowledge and other resources they use, and (c) a balance of evidence-based planning and informed adaptation. We encourage the diverse community of scientists, providers, and administrators in our field to come together to enhance our collective wisdom through consideration of and reflection on these concepts and their illustrations.
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Affiliation(s)
- Bruce F Chorpita
- a Department of Psychology , University of California , Los Angeles
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Chorpita BF, Weisz JR, Daleiden EL, Schoenwald SK, Palinkas LA, Miranda J, Higa-McMillan CK, Nakamura BJ, Austin AA, Borntrager CF, Ward A, Wells KC, Gibbons RD. Long-term outcomes for the Child STEPs randomized effectiveness trial: a comparison of modular and standard treatment designs with usual care. J Consult Clin Psychol 2013; 81:999-1009. [PMID: 23978169 DOI: 10.1037/a0034200] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This article reports outcomes from the Child STEPs randomized effectiveness trial conducted over a 2-year period to gauge the longer term impact of protocol design on the effectiveness of evidence-based treatment procedures. METHOD An ethnoracially diverse sample of 174 youths ages 7- 13 (N = 121 boys) whose primary clinical concerns involved diagnoses or clinical elevations related to anxiety, depression, or disruptive behavior were treated by community therapists randomly assigned to 1 of 3 conditions: (a) standard, which involved the use of 1 or more of 3 manualized evidence-based treatments, (b) modular, which involved a single modular protocol (Modular Approach to Treatment of Children With Anxiety, Depression, or Conduct Problems; MATCH) having clinical procedures similar to the standard condition but flexibly selected and sequenced using a guiding clinical algorithm, and (c) usual care. RESULTS As measured with combined Child Behavior Checklist and Youth Self-Report Total Problems, Internalizing, and Externalizing scales, the rate of improvement for youths in the modular condition was significantly better than for those in usual care. On a measure of functional impairment (Brief Impairment Scale), no significant differences were found among the 3 conditions. Analysis of service utilization also showed no significant differences among conditions, with almost half of youths receiving some additional services in the 1st year after beginning treatment, and roughly one third of youths in the 2nd year. CONCLUSIONS Overall, these results extend prior findings, supporting incremental benefits of MATCH over usual care over a 2-year period.
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Becker KD, Lee BR, Daleiden EL, Lindsey M, Brandt NE, Chorpita BF. The Common Elements of Engagement in Children's Mental Health Services: Which Elements for Which Outcomes? Journal of Clinical Child & Adolescent Psychology 2013; 44:30-43. [DOI: 10.1080/15374416.2013.814543] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | | | | | - Nicole E. Brandt
- a Department of Psychiatry , University of Maryland School of Medicine
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Regan J, Daleiden EL, Chorpita BF. Integrity in mental health systems: An expanded framework for managing uncertainty in clinical care. Clinical Psychology: Science and Practice 2013. [DOI: 10.1111/cpsp.12024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ward AM, Regan J, Chorpita BF, Starace N, Rodriguez A, Okamura K, Daleiden EL, Bearman SK, Weisz JR, The Research Network on Youth Menta. Tracking Evidence Based Practice with Youth: Validity of the MATCH and Standard Manual Consultation Records. Journal of Clinical Child & Adolescent Psychology 2013; 42:44-55. [DOI: 10.1080/15374416.2012.700505] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
OBJECTIVE The Monthly Treatment and Progress Summary (MTPS) was developed to assess treatment techniques applied in clinical practice. This study examined the factor structure of the reported therapeutic practice elements on the MTPS and explored patterns in technique use based on client and therapist characteristics in a community mental health setting. METHODS MTPS data from 278 lead therapists in Hawai'i's local system of care were extracted from the online state mental health information management system. Therapists' endorsements (yes-no) of each practice element were examined across 278 completed youth treatment episodes, and an exploratory factor analysis with varimax rotation was conducted on the categorical data set. RESULTS Three factors emerged from the analyses: behavior management (behavioral interventions), coping and self-control (self-change practices), and family interventions (family supports). Treatment teams with licensed therapists reported higher use of coping and self-control practice elements, whereas teams with unlicensed therapists and paraprofessionals reported greater use of behavior management practice elements. Lead therapists reported that teams treating younger clients and those with attentional disorders were more likely to use behavior management practice elements, and teams treating youths with more severe impairment at intake utilized more behavior management and family intervention practice elements. CONCLUSIONS Overall, the MTPS shows promise as a therapist report of practices. The finding that practice elements organized into theoretical patterns and were applied in expected ways suggests a thoughtful approach to usual care techniques. With the increased focus on health care reform and managed care, the MTPS can inform system monitoring, feedback, and improvement.
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Affiliation(s)
- Trina E Orimoto
- Department of Psychology, University of Hawai'i at Manoa, 2530 Dole St, Sakamaki C 400, Honolulu, HI 96822, USA.
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Southam-Gerow MA, Rodríguez A, Chorpita BF, Daleiden EL. Dissemination and implementation of evidence based treatments for youth: Challenges and recommendations. ACTA ACUST UNITED AC 2012. [DOI: 10.1037/a0029101] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chorpita BF, Bernstein A, Daleiden EL. Empirically guided coordination of multiple evidence-based treatments: an illustration of relevance mapping in children's mental health services. J Consult Clin Psychol 2011; 79:470-80. [PMID: 21787050 DOI: 10.1037/a0023982] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Despite substantial progress in the development and identification of psychosocial evidence-based treatments (EBTs) in mental health, there is minimal empirical guidance for selecting an optimal set of EBTs maximally applicable and generalizable to a chosen service sample. Relevance mapping is a proposed methodology that addresses this problem through structured comparison of client characteristics in a service sample to participant characteristics from studies of EBTs. METHOD The authors demonstrate the feasibility of relevance mapping using data from 1,781 youths in a statewide mental health system and a study data set including 437 randomized clinical trials. Relevance mapping (a) reveals who is "coverable" by any EBT, under different definitions of matches between study participants and clients, and (b) identifies minimum sets of treatments needed to serve maximum numbers of clients, across different levels of analysis for defining treatment operations. RESULTS In the illustration sample, all problems targeted by the study data set review were fully coverable when matching only required clients to have the same problem as EBT study participants. At the other extreme, when matching also required age, gender, ethnicity, and setting, the percentage of noncoverable youths increased to 86% in this sample. Two minimal sets of only 8 EBTs were identified that, when added to the one EBT already in place in that system, covered 100% of coverable youths when matching required problem, age, and gender. CONCLUSIONS This methodology offers promise for the empirically guided selection and coordination of EBTs, thereby addressing one aspect of the gap between knowledge and practice.
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Affiliation(s)
- Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles 90095-1563, USA.
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Weisz JR, Chorpita BF, Palinkas LA, Schoenwald SK, Miranda J, Bearman SK, Daleiden EL, Ugueto AM, Ho A, Martin J, Gray J, Alleyne A, Langer DA, Southam-Gerow MA, Gibbons RD. Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: a randomized effectiveness trial. ACTA ACUST UNITED AC 2011; 69:274-82. [PMID: 22065252 DOI: 10.1001/archgenpsychiatry.2011.147] [Citation(s) in RCA: 485] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Decades of randomized controlled trials have produced separate evidence-based treatments for depression, anxiety, and conduct problems in youth, but these treatments are not often used in clinical practice, and they produce mixed results in trials with the comorbid, complex youths seen in practice. An integrative, modular redesign may help. OBJECTIVE Standard/separate and modular/integrated arrangements of evidence-based treatments for depression, anxiety, and conduct problems in youth were compared with usual care treatment, with the modular design permitting a multidisorder focus and a flexible application of treatment procedures. DESIGN Randomized effectiveness trial. SETTING Ten outpatient clinical service organizations in Massachusetts and Hawaii. PARTICIPANTS A total of 84 community clinicians were randomly assigned to 1 of 3 conditions for the treatment of 174 clinically referred youths who were 7 to 13 years of age (70% of these youths were boys, and 45% were white). The study was conducted during the period from January 12, 2005 to May 8, 2009. INTERVENTIONS Standard manual treatment (59 youths [34% of the sample]; cognitive behavioral therapy for depression, cognitive behavioral therapy for anxiety, and behavioral parent training for conduct problems), modular treatment (62 youths [36%]; integrating the procedures of the 3 separate treatments), and usual care (53 youths [30%]). MAIN OUTCOME MEASURES Outcomes were assessed using weekly youth and parent assessments. These assessments relied on a standardized Brief Problem Checklist and a patient-generated Top Problems Assessment (ie, the severity ratings on the problems that the youths and parents had identified as most important). We also conducted a standardized diagnostic assessment before and after treatment. RESULTS Mixed effects regression analyses showed that modular treatment produced significantly steeper trajectories of improvement than usual care and standard treatment on multiple Brief Problem Checklist and Top Problems Assessment measures. Youths receiving modular treatment also had significantly fewer diagnoses than youths receiving usual care after treatment. In contrast, outcomes of standard manual treatment did not differ significantly from outcomes of usual care. CONCLUSIONS The modular approach outperformed usual care and standard evidence-based treatments on multiple clinical outcome measures. The modular approach may be a promising way to build on the strengths of evidence-based treatments, improving their utility and effectiveness with referred youths in clinical practice settings. Trial Registration clinicaltrials.gov Identifier: NCT01178554.
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Affiliation(s)
- John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA 02138, USA.
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Chorpita BF, Daleiden EL, Ebesutani C, Young J, Becker KD, Nakamura BJ, Phillips L, Ward A, Lynch R, Trent L, Smith RL, Okamura K, Starace N. Evidence‐based treatments for children and adolescents: An updated review of indicators of efficacy and effectiveness. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1468-2850.2011.01247.x] [Citation(s) in RCA: 186] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chorpita BF, Daleiden EL. Mapping evidence-based treatments for children and adolescents: application of the distillation and matching model to 615 treatments from 322 randomized trials. J Consult Clin Psychol 2009; 77:566-79. [PMID: 19485596 DOI: 10.1037/a0014565] [Citation(s) in RCA: 353] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study applied the distillation and matching model to 322 randomized clinical trials for child mental health treatments. The model involved initial data reduction of 615 treatment protocol descriptions by means of a set of codes describing discrete clinical strategies, referred to as practice elements. Practice elements were then summarized in profiles, which were empirically matched to client factors (i.e., observed problem, age, gender, and ethnicity). Results of a profile similarity analysis demonstrated a branching of the literature into multiple problem areas, within which some age and ethnicity special cases emerged as higher order splits. This is the 1st study to aggregate evidence-based treatment protocols empirically according to their constituent treatment procedures, and the results point both to the overall organization of therapy procedures according to matching factors and to gaps in the current child and adolescent treatment literature.
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Affiliation(s)
- Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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Higa CK, Daleiden EL. Social anxiety and cognitive biases in non-referred children: The interaction of self-focused attention and threat interpretation biases. J Anxiety Disord 2008; 22:441-52. [PMID: 17583471 DOI: 10.1016/j.janxdis.2007.05.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 05/08/2007] [Accepted: 05/17/2007] [Indexed: 11/16/2022]
Abstract
Cognitive-behavioral models of social phobia emphasize the combined effects of cognitive biases in the maintenance of the condition, and recent findings in adults implicate self-focused attention as one such bias. However, research examining self-focus in youth is limited. This investigation examined the causal role of self-focused attention on threat interpretation biases in a community sample of 175 socially anxious children. Self-focused attention was experimentally induced via a mirror manipulation procedure and self-focused attention was assessed before and after mirror exposure. Social interpretation biases were examined via an ambiguous stories task with half of the children completing the task in front of a mirror and the other half without a mirror. Social anxiety predicted self-focus and threat interpretation bias. The mirror manipulation did not have an effect on focus of attention or on threat interpretation bias, nor did it interact with social anxiety. Implications and future research directions are discussed.
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Affiliation(s)
- Charmaine K Higa
- Department of Psychology, University of Hawai'i at Mānoa, 2430 Campus Road, Honolulu, HI 96822, United States.
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Schiffman J, Chorpita BF, Daleiden EL, Maeda JA, Nakamura BJ. Service Profile of Youths with Schizophrenia-Spectrum Diagnoses. Child Youth Serv Rev 2008; 30:427-436. [PMID: 18516252 PMCID: PMC2405956 DOI: 10.1016/j.childyouth.2007.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Jason Schiffman
- All authors are affiliated with the University of Hawaii at Manoa, 2430 Campus Road, Gartley 110, Honolulu, Hawaii, 96822
| | - Bruce F. Chorpita
- All authors are affiliated with the University of Hawaii at Manoa, 2430 Campus Road, Gartley 110, Honolulu, Hawaii, 96822
| | - Eric L. Daleiden
- All authors are affiliated with the University of Hawaii at Manoa, 2430 Campus Road, Gartley 110, Honolulu, Hawaii, 96822
| | - Justin A. Maeda
- All authors are affiliated with the University of Hawaii at Manoa, 2430 Campus Road, Gartley 110, Honolulu, Hawaii, 96822
| | - Brad J. Nakamura
- All authors are affiliated with the University of Hawaii at Manoa, 2430 Campus Road, Gartley 110, Honolulu, Hawaii, 96822
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Young J, Daleiden EL, Chorpita BF, Schiffman J, Mueller CW. Assessing stability between treatment planning documents in a system of care. Adm Policy Ment Health 2007; 34:530-9. [PMID: 17846879 DOI: 10.1007/s10488-007-0137-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 08/15/2007] [Indexed: 11/30/2022]
Abstract
Two studies were performed to examine the presence and stability of specific recommendations for treatment practices in a system of care. Study 1 evaluated the reliability of an instrument designed to quantify specific elements of treatment planning documents. Study 2 used reliably coded data from Study 1 to assess stability of treatment practices and targets across the treatment planning process. This study indicated a generally low level of agreement of between documents, with many specific recommendations being dropped between stages of planning. The implications of these findings and the potential for future research are discussed.
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Affiliation(s)
- John Young
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI 96822, USA.
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Affiliation(s)
- Bruce F Chorpita
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI 96822, USA.
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Higa CK, Fernandez SN, Nakamura BJ, Chorpita BF, Daleiden EL. Parental Assessment of Childhood Social Phobia: Psychometric Properties of the Social Phobia and Anxiety Inventory for Children–Parent Report. Journal of Clinical Child & Adolescent Psychology 2006; 35:590-7. [PMID: 17007605 DOI: 10.1207/s15374424jccp3504_11] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Validity and parent-child agreement of the Social Phobia and Anxiety Inventory for Children-Parent Report (SPAI-C-P) were examined in a racially diverse sample of 158 students in Grades 5 through 8 (87 girls; ages 10 to 14; M = 11.53) and their caregivers. Children completed the Social Phobia and Anxiety Inventory for Children (SPAI-C), and caregivers completed the SPAI-C-P and the Child Behavior Checklist (CBCL). The SPAI-C-P demonstrated good internal consistency and was significantly correlated with child self-reported social anxiety. Confirmatory factor analysis supported a 3-factor model over a 5-factor model, and concurrent validity was evidenced. Implications and directions for future research are discussed.
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Affiliation(s)
- Charmaine K Higa
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI 96822, USA.
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Daleiden EL, Chorpita BF, Donkervoet C, Arensdorf AM, Brogan M. Getting better at getting them better: health outcomes and evidence-based practice within a system of care. J Am Acad Child Adolesc Psychiatry 2006; 45:749-56. [PMID: 16721326 DOI: 10.1097/01.chi.0000215154.07142.63] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Eric L Daleiden
- Hawaii Department of Health Child and Adolescent Mental Health Division, Honolulu, USA.
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Schiffman J, Becker KD, Daleiden EL. Evidence-Based Services in a Statewide Public Mental Health System: Do the Services Fit the Problems? Journal of Clinical Child & Adolescent Psychology 2006; 35:13-9. [PMID: 16390299 DOI: 10.1207/s15374424jccp3501_2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study examined the degree to which a literature review of evidence-based services identified services appropriate for the actual problems of youth involved in intensive public mental health services. The diagnostic profiles and specific intervention targets reported by treatment providers were coded to determine whether a relevant empirically supported treatment was identified in the literature by the Hawaii Evidence-Based Services Committee for each problem. Of the 2,197 youth with diagnostic information available, 721 youth (33%) had a pure diagnosis for which an evidence-based service was identified in the literature, and 1,953 youth (89%) had a primary diagnosis with a relevant evidence-based service. Of the 1,220 youth with treatment target information, 1,094 (90%) had 1 or more problem areas targeted for intervention with an identified evidence-based service; thus, the vast majority of youth receiving intensive public mental services experienced a mental health difficulty for which an evidence-based service was identified through a review of the empirical literature. Nevertheless, many youth had additional problems for which evidence-based services have not yet been identified through research.
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Affiliation(s)
- Jason Schiffman
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI 96822, USA.
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Abstract
BACKGROUND Population and service characteristics were compared for youth (age 0-18 years) with and without schizophrenia-spectrum disorders, who received public mental health services in Hawaii's comprehensive system of care between July 1, 2000 and June 30, 2001. METHODS Electronic records of youth with a diagnosis in the schizophrenia-spectrum (n=71) were compared to all other youth (n=13,904) who received services with respect to age, gender, ethnicity, comorbidity, type of service, and service cost. RESULTS The schizophrenia-spectrum group had higher Asian representation, greater comorbidity, and was more likely to receive restrictive services for a higher average annual expense. When restrictive services were provided, they were of similar duration and intensity across groups. Almost all youth received less intensive services, but the schizophrenia-spectrum group received a higher frequency or longer duration of such services. CONCLUSIONS Although youth with schizophrenia-spectrum disorders were uncommon, collectively they represented a distinct population with above average service consumption. Future monitoring of interventions and outcomes may help develop systematic and effective treatment strategies for youth with schizophrenia-spectrum disorders.
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Chorpita BF, Daleiden EL, Weisz JR. Identifying and selecting the common elements of evidence based interventions: a distillation and matching model. ACTA ACUST UNITED AC 2005; 7:5-20. [PMID: 15832690 DOI: 10.1007/s11020-005-1962-6] [Citation(s) in RCA: 386] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A model is proposed whereby the intervention literature can be empirically factored or distilled to derive profiles from evidence-based approaches. The profiles can then be matched to individual clients based on consideration of their target problems, as well as demographic and contextual factors. Application of the model is illustrated by an analysis of the youth treatment literature. Benefits of the model include its potential to facilitate improved understanding of similarities and differences among treatments, to guide treatment selection and matching to clients, to address gaps in the literature, and to point to possibilities for new interventions based on the current research base.
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Affiliation(s)
- Bruce F Chorpita
- Department of Psychology, University of Hawaii, Honolulu, Hawaii 96822, USA.
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Daleiden EL, Chorpita BF. From data to wisdom: quality improvement strategies supporting large-scale implementation of evidence-based services. Child Adolesc Psychiatr Clin N Am 2005; 14:329-49, x. [PMID: 15694789 DOI: 10.1016/j.chc.2004.11.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Hawaii Department of Health Child and Adolescent Mental Health Division has explored various strategies to promote widespread use of empirical evidence to improve the quality of services and outcomes for youth. This article describes a core set of clinical decisions and how several general and local evidence bases may inform those decisions. Multiple quality improvement strategies are illustrated in the context of a model that outlines four phases of evidence: data, information, knowledge, and wisdom.
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Affiliation(s)
- Eric L Daleiden
- Child and Adolescent Mental Health Division, Hawaii Department of Health, 3627 Kilauea Avenue, Room101, Honolulu, HI 96816, USA.
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Chorpita BF, Daleiden EL. Designs for instruction, designs for change: Distributing knowledge of evidence-based practice. ACTA ACUST UNITED AC 2004. [DOI: 10.1093/clipsy.bph088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chorpita BF, Daleiden EL. Tripartite dimensions of emotion in a child clinical sample: measurement strategies and implications for clinical utility. J Consult Clin Psychol 2002. [PMID: 12362965 DOI: 10.1037//0022-006x.70.5.1150] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Several measurement strategies to assess the tripartite model of emotion in child and adolescent samples have been developed. However, no studies have comparatively examined the most suitable strategies in clinical samples of children and adolescents. This study involved the evaluation of 2 distinct measures of tripartite constructs relative to anxiety and depression criterion variables in a clinical sample of 226 children in Grades 1 through 12. Results indicated that the measures performed similarly overall, but some differences were pronounced enough to suggest that the measures indexed slightly different aspects of the same constructs. These differences appear consistent with the scale design of each instrument. Implications for measurement of these constructs in future research are highlighted.
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Affiliation(s)
- Bruce F Chorpita
- Department of Psychology, University of Hawaii at Manoa, Honolulu 96822, USA.
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Chorpita BF, Daleiden EL. Tripartite dimensions of emotion in a child clinical sample: measurement strategies and implications for clinical utility. J Consult Clin Psychol 2002; 70:1150-60. [PMID: 12362965 DOI: 10.1037/0022-006x.70.5.1150] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Several measurement strategies to assess the tripartite model of emotion in child and adolescent samples have been developed. However, no studies have comparatively examined the most suitable strategies in clinical samples of children and adolescents. This study involved the evaluation of 2 distinct measures of tripartite constructs relative to anxiety and depression criterion variables in a clinical sample of 226 children in Grades 1 through 12. Results indicated that the measures performed similarly overall, but some differences were pronounced enough to suggest that the measures indexed slightly different aspects of the same constructs. These differences appear consistent with the scale design of each instrument. Implications for measurement of these constructs in future research are highlighted.
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Affiliation(s)
- Bruce F Chorpita
- Department of Psychology, University of Hawaii at Manoa, Honolulu 96822, USA.
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Parker JD, Daleiden EL, Simpson CA. Personality Assessment Inventory substance-use scales: Convergent and discriminant relations with the Addiction Severity Index in a residential chemical dependence treatment setting. Psychol Assess 1999. [DOI: 10.1037/1040-3590.11.4.507] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Daleiden EL, Chorpita BF, Kollins SH, Drabman RS. Factors affecting the reliability of clinical judgments about the function of children's school-refusal behavior. J Clin Child Psychol 1999; 28:396-406. [PMID: 10446689 DOI: 10.1207/s15374424jccp280312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Conducted two studies to examine the interrater reliability, test-retest stability, and the effect of various clinician variables, such as years of clinical experience, theoretical orientation, and prior experience with children, on clinical judgments about the reinforcement functions of children's school-refusal behavior. Results indicated that the judgments by individual clinicians were of questionable reliability. Judgments aggregated across 3 clinicians yielded acceptable interrater and test-retest reliability in Study 1, but a greater number of clinicians were necessary to achieve acceptable reliability in Study 2. Years of clinical experience and training were the only clinician variables related to the reliability of judgments about reinforcement functions. Several recommendations for the clinical assessment of the function of children's school-refusal behavior are discussed.
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Affiliation(s)
- E L Daleiden
- Department of Psychology, University of Tulsa, OK 74104, USA.
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Abstract
Information-processing models of childhood anxiety highlight the centrality of memory processes in the maintenance and intensification of anxiety. Recent advances in memory research allow for an increasingly fine-grained analysis of the relation between anxiety and memory. The relation between childhood anxiety and memory was examined in a sample of 160 high- and low-trait-anxious sixth through eighth grade children. Results indicated that anxiety predicted a memory bias toward negative relative to neutral information during conceptual but not perceptual tasks. Further, anxiety predicted a memory bias toward positive relative to neutral information on procedural tasks and a memory bias away from positive relative to neutral information on declarative tasks. These findings accent the complexity and multidimensionality of relations among childhood anxiety, the emotional valence of stimuli, types of cognitive processing, and memory systems in contributing to biases in children's memory functioning.
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Affiliation(s)
- E L Daleiden
- Department of Psychology, University of Tulsa, OK 74104, USA.
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Chorpita BF, Barlow DH, Albano AM, Daleiden EL. Methodological strategies in child clinical trials: advancing the efficacy and effectiveness of psychosocial treatments. J Abnorm Child Psychol 1998; 26:7-16. [PMID: 9566542 DOI: 10.1023/a:1022626505280] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The present paper reviews issues of treatment efficacy (i.e., potency) and effectiveness (i.e., clinical utility) in applied clinical child research. Threats to treatment evaluation are reviewed in the context of these two dimensions. It is proposed that treatment outcome research faces new challenges stemming from the ever increasing emphasis on generalization of gains and dissemination of interventions outside of clinical research settings. Issues and approaches proposed as warranting further development and attention include development, flexibility, acceptability, and disseminability of psychosocial assessment and treatment methods. A research emphasis is promoted that balances experimental control with the need for treatment generalization and delivery outside of the research setting, in order to maximize the utility of clinical research.
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Affiliation(s)
- B F Chorpita
- University of Albany, State University of New York, 12222, USA
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