Research Projects
Current Projects
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 and University of Oregon on this project.
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.
Effects of Mental Health Interventions Delivered in Schools: A Meta-Analysis
At least 20% of school-aged youths in the U.S. experience significant mental health challenges involving social, emotional, or behavioral (SEB) problems. More of these youths receive mental health interventions in schools than in mental health clinics, hospitals, or any other setting. Yet, most of the evidence on effects of these interventions comes from non-school settings; we know too little about how well the interventions work when delivered in schools. The proposed project, funded by the U.S. Institute of Education Sciences, will address that gap via the most rigorous and complete synthesis to date of studies that have tested mental health interventions in schools. We will test the overall effectiveness of the interventions, test for factors that make the interventions most and least successful, and investigate a critical question in education: Do improvements in students’ mental health lead to improvements in their functioning and academic performance in school? The project is a meta-analysis synthesizing an estimated 300 studies testing interventions for students in school settings. The studies will include K-12 students, treated for problems including depression, anxiety (including post-traumatic stress and OCD), conduct problems (including disruptive and aggressive behavior), and ADHD (including attention problems). Methods will include tests of the main effects of the interventions, tests of factors that might enhance or diminish intervention outcomes, and tests of whether improved mental health leads to improved student functioning and academic performance. This meta-analysis will produce the most comprehensive picture to date of how effective mental health interventions for social, emotional, and behavioral problems are when implemented within schools. The project will also provide information on which intervention, student, and school characteristics are associated with best and worst intervention outcomes. Finally, tests of mediation will provide information on the extent to which improvement in students’ mental health leads to improvements in their functioning and academic performance.
Completed Projects
Digital Mental Health Interventions for Ukrainian Children: Two Trials
This project included two randomized controlled trials, testing digital mental health interventions for children and adolescents that were delivered in schools. Both trials, conducted with Ukrainian youths, tested whether the interventions might reduce symptoms of anxiety and depression, which have been shown to be common among war-exposed Ukrainian youths. One trial tested Project SOLVE, a 30-minute intervention that teaches problem-solving skills to Ukrainian children and adolescents who have fled the war by emigrating to Poland. These children face diverse problem-solving challenges associated with assimilating into, and attending school within, a country where the language and customs are unfamiliar, and the youths face other challenges linked to separation from fathers, brothers, and other family members who have remained in Ukraine. The trial tested whether Project SOLVE, administered in schools via tablets and phones, has beneficial effects on symptoms of depression, anxiety, and/or disruptive conduct. The second trial was a test of Project CALM, a 30-minute intervention that teaches a set of strategies for self-calming during times of stress. This trial is conducted in Ukraine, in a region frequently targeted by Russian missile and drone attacks, sending young people and their family members to shelters, frequently during school hours. For this reason, Project CALM seems especially relevant to the lives of these children and adolescents. The two trials tested whether the digital interventions, administered online in schools, via tablets and cell phones, would reduce anxiety and depression symptoms. The two studies have been through peer review and are now published. The Project SOLVE article can be found HERE, and the Project CALM article can be found HERE.
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 some prior studies based mainly in mental health clinics, but its modular, transdiagnostic design seems well-suited to school-based mental health services. This project tested STEPs with 142 elementary and middle school students from five urban and suburban school districts in the greater Boston area. Data collection and analyses have been completed, and the study report is now under journal review. In addition, an ancillary qualitative study reported on what conditions for mental health care are like in schools, and discussed barriers and facilitators to MATCH implementation in those settings.
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.