FIRST: A Principle-Guided Approach to Evidence-Based Youth Psychotherapy
During the past half-century, researchers have developed treatments for a broad array of child and adolescent mental health and behavioral problems. Very few of these treatments, however, have made their way into everyday clinical practice. To address this gap, we have developed a treatment approach called FIRST, which builds on five core principles of evidence-based treatment for internalizing and externalizing problems. The treatment approach—derived from the evidence base and designed to be brief and efficient—has benefitted from the feedback of both practicing clinicians and expert treatment developers. We recently completed an initial open trial, funded by the National Institute of Mental Health, in which FIRST was used by clinic-based practitioners treating youths who had been referred to their clinics. In this trial, FIRST scored well (1) on measures of feasibility and acceptability for clients (i.e., youths and caregivers) and clinicians and (2) on clinical outcomes, matching or exceeding the corresponding scores in benchmarking comparisons with previous studies of other treatments. Weekly assessments throughout treatment showed effect sizes for clinical improvement ranging from .41 to 2.66 on weekly total problems and problems deemed "most important" by youths and caregivers. In two subsequent open trials, in which FIRST was limited to six sessions and delivered by novice clinicians, acceptability, integrity, and symptom improvement were comparable to prior studies.
We are now working on an NIMH-funded multisite randomized controlled effectiveness trial of FIRST. We have partnered with community mental health clinics in Boston, MA and Austin, TX and are working with our colleagues at the University of Texas on this project.
School Outcomes of Integrative Mental Health Services (CARES Project)
Child STEPs, the combination of MATCH and a clinical monitoring and feedback system, has shown positive effects in prior studies, and its design is particularly well-suited to school-based mental health services. A recent RCT with more than a third of the child sample treated in schools, found STEPS more effective than both usual care and standard evidence-based treatments, but the trial included only mental health outcomes. The purpose of this project is to establish the effectiveness of the STEPs in Boston-area public school districts. This project will compare the impact of STEPs versus usual school-based therapy on students’ mental health and school-related outcomes, and test whether changes in school outcomes are mediated by changes in student mental health. If so, this could suggest a path to improved school functioning for students who face emotional and behavioral difficulties. Additional biological measures will provide information on mental processes (e.g., self-regulation) that may help explain treatment benefit. We recently completed data collection, and an ancillary qualitative study revealed several barriers and facilitators to MATCH implementation in schools.
Meta-Analyses of Youth Treatment Outcome Research
As a complement to our own empirical studies, we review the research of many other investigators who study youth intervention and its effects. We conduct meta-analyses and systematic reviews of youth treatment outcome research in an effort to characterize the state of knowledge in the field and suggest ways to improve research and practice. As one example, two of our meta-analyses have examined a critical question: Do evidence-based youth treatments actually produce better outcomes than usual clinical care in everyday practice? Our various meta-analyses, reviews, and related critiques, can be found in the Lab Publications section of this website.
Connecticut Child STEPs
The purpose of this 5-year project was to establish the effectiveness of MATCH in outpatient clinics in the state of Connecticut. Specifically, we conducted a randomized controlled trial (RCT) comparing the Child STEPs model with consultation from expert MATCH consultants to training in the Child STEPs model without ongoing consultation. We found that both MATCH competence and clinical outcomes were strong, positive, and highly similar across both conditions, suggesting that effective invervention implementation may be supported by more cost-effective and less logistically-challenging procedures.
Clinic Treatment and Sustainability Studies
The Child STEPs Clinic Treatment Projects, funded by the MacArthur Foundation, the Annie E. Casey Foundation, Casey Family Programs, and the Norlien Foundation, included intervention trials carried out within community mental health care settings. These studies tested the effectiveness of an integrative approach to evidence-based treatment for youth disorders and problems involving anxiety, depression, post-traumatic stress, and/or disruptive conduct. The treatment protocol used in these studies is the Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH). In each study, we compared the outcomes achieved by community clinicians when using MATCH as compared to alternative interventions, including treatment-as-usual (i.e., “usual care”). These studies provided evidence for MATCH effectiveness when used in real-world community clinics and paired with the experience and skills of dedicated community-based practitioners.