School Outcomes of Integrative Mental Health Services (CARES Project)
Child STEPs (STEPs), the combination of MATCH and a clinical monitoring and feedback system, has shown positive effects, 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.
Connecticut Child STEPs
The purpose of this 5-year project is to establish the effectiveness of the MATCH intervention in Connecticut outpatient clinics. One component of the project (years 1 - 5) will be 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. Another component of the project (years 3 - 5) will be MATCH dissemination via implementation of MATCH Learning Collaboratives in an anticipated 14-18 clinical agencies throughout the state of Connecticut.
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.
FIRST: A Principal-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 have made their way into everyday clinical practice. To help address this gap between clinical science and clinical practice, we have developed a treatment approach called FIRST, which builds on five core principles of evidence-based treatment for internalizing and externalizing problems and disorders. 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 on measures of feasibility, acceptability to clients (youths and caregivers) and clinicians, and--importantly--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 caregivers and youths. The findings are encouraging. We hope to move next to a large-sample randomized controlled effectiveness trial of FIRST.
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, are intervention trials carried out within community mental health care settings. These studies test 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-ADTC; Chorpita & Weisz, 2009). In each study, we compare the outcomes achieved by community clinicians when using MATCH as compared to alternative interventions, including treatment-as-usual, or “usual care.” We want to learn the effects of MATCH when used in real-world community clinics and paired with the experience and skills of dedicated community-based practitioners. Full Project Description Here.
Consumer and Clinician Feedback
Recent calls for the expansion of evidence-based practices for youth have stressed the need to incorporate assessment data on treatment response into everyday clinical care. Receiving frequent outcome data can help clinicians understand, during treatment, whether their clients are responding, whether and when mid-course changes in treatment strategy are needed, which changes are effective, and when treatment gains have been achieved and treatment can end.
The purpose of this project is to address these issues in the context of youth outpatient treatment by (a) using qualitative methods to obtain feedback from stakeholders (caregivers, youths, clinicians, clinic staff, and administrators) regarding desired features of a monitoring and feedback system for youth mental health care; (b) modifying the existing monitoring and feedback system, TRAC (Treatment Response Assessment for Children), in response to stakeholder feedback, piloting it in two outpatient clinics, and revising it further based on quantitative and qualitative assessments of its use and its utility; and (c) conducting a small-sample RCT with the revised TRAC.