The impact of early therapeutic alliance was examined in 100 clients receiving either individual cognitive- behavioral therapy (CBT) or family therapy for adolescent substance abuse. Observational ratings of adolescent alliance in CBT and adolescent and parent alliance in family therapy were used to predict treatment retention (in CBT only) and outcome (drug use, externalizing, and internalizing symptoms in both conditions) at post and 6-month follow-up. There were no alliance effects in CBT. In family therapy, stronger parent alliance predicted declines in drug use and externalizing. Adolescents with weak early alliances that subsequently improved by midtreatment showed significantly greater reductions in externalizing than adolescents whose alliances declined. Results underscore the need for ongoing developmental calibration of intervention theory and practice for adolescent clinical populations.

BackgroundSome outcomes for children with mental health problems remain suboptimal because of poor access to care and the failure of systems and providers to adopt established quality improvement strategies and interventions with proven effectiveness. This review had three goals: (1) assess the effectiveness of quality improvement, implementation, and dissemination strategies intended to improve the mental health care of children and adolescents; (2) examine harms associated with these strategies; and (3) determine whether effectiveness or harms differ for subgroups based on system, organizational, practitioner, or patient characteristics.MethodsSources included MEDLINE®, the Cochrane Library, PsycINFO, and CINAHL, from database inception through February 17, 2017. Additional sources included gray literature, additional studies from reference lists, and technical experts. Two reviewers selected relevant randomized controlled trials (RCTs) and observational studies, extracted data, and assessed risk of bias. Dual analysis, synthesis, and grading of the strength of evidence for each outcome followed for studies meeting inclusion criteria. We also used qualitative comparative analysis to examine relationships between combinations of strategy components and improvements in outcomes.ResultsWe identified 18 strategies described in 19 studies. Eleven strategies significantly improved at least one measure of intermediate outcomes, final health outcomes, or resource use. Moderate strength of evidence (from one RCT) supported using provider financial incentives such as pay for performance to improve the competence with which practitioners can implement evidence-based practices (EBPs). We found inconsistent evidence involving strategies with educational meetings, materials, and outreach; programs appeared to be successful in combination with reminders or providing practitioners with newly collected clinical information. We also found low strength of evidence for no benefit for initiatives that included only educational materials or meetings (or both), or only educational materials and outreach components. Evidence was insufficient to draw conclusions on harms and moderators of interventions.ConclusionsSeveral strategies can improve both intermediate and final health outcomes and resource use. This complex and heterogeneous body of evidence does not permit us to have a high degree of confidence about the efficacy of any one strategy because we generally found only a single study testing each strategy.Trial registrationPROSPERO, CRD42015024759.

This study examined outcomes for 320 youth in a Center for Mental Health Services system-of-care demonstration site. Youth received wraparound-only ( n = 213), MST-only ( n = 54), or wraparound + MST ( n = 53). Participants were 12 years old on average and mostly White (90%), and 75% were Medicaid-eligible. Service use and functional and clinical outcomes were examined at 6-month intervals out to 18 months.All three groups improved over the study period. The MST-only group demonstrated more clinical improvement than the other groups. Functional outcomes did not differ significantly across groups.Youth in wrap + MST had higher baseline severity and experienced less clinical and functional change than the other two groups, despite more mental health service use. Targeted, evidence-based treatment may be more effective than system-level intervention alone for improving clinical symptoms among youth with serious emotional disorders served in community-based settings. New or amended approaches may be needed for youth with the most severe disorders.

Highlights HEALing Communities Study is a parallel-group cluster randomized controlled trial. Communities That HEAL intervention’s goal is to reduce opioid overdose deaths. Structured consensus decision-making strategy guided study measure development. More than 80 study measure specifications and a common data model were developed. The study will provide methodology and longitudinal community data for research.

Highlights An approach to community implementation of evidence-based practices (EBPs) was needed. The Opioid-overdose Reduction Continuum of Care Approach (ORCCA) was developed. ORCCA outlines: evidence-based strategies, priority populations, community settings. ORCCA is a flexible framework for EBP implementation to reduce opioid-overdose deaths.