Community-Based Providers’ Selection of Practices for Children and Adolescents With Comorbid Mental Health Problems

Abstract

The goal of this study is to explore providers’ patterns of implementation by investigating how community mental health providers selected therapy practice modules from a flexible, modular evidence-based treatment working with youths with comorbid mental health problems. Data were obtained from 57 youths, 5–15 years old, presenting with anxiety, depressive, and/or conduct problems and their 27 providers during their participation in an effectiveness trial involving a modular evidence-based treatment. Although all youths evidenced clinically elevated symptomatology in at least two problem areas, providers targeted youths’ comorbid problems with only about half of their study cases. Practice modules indicated for youths’ comorbid problems were typically used less frequently and with less depth relative to practice modules indicated for youths’ principal clinical problem and were often transdiagnostic in nature (i.e., designed to target more than one problem area). To determine whether providers’ decisions to target youths’ comorbid problems were systematic, multilevel, logistic regression analyses were conducted and revealed that youths’ pretreatment characteristics and time in therapy influenced providers’ patterns of module selection. Providers tend to use, but not exploit, the flexibility allowed by modular EBTs and to focus treatment on youths’ principal presenting problem. In addition, providers appear to make these practice choices in a systematic and rational manner, and whether and which choices are associated with improved outcomes is an important area of future study.

Outcomes Associated With Adapting a Research-Supported Treatment for Children With Behavior Disorders

“…Over the past 30 years, research has advanced the treatment of serious mental health disorders during childhood and adolescence such as depression, anxiety, and disruptive behavior disorders (Hoagwood et al, 2014; Mufson & Moreau, 1999). However, few research-supported treatments (RSTs) reach children in need (Marques et al, 2016; Park, Moskowitz, & Chorpita, 2018; Ringle et al, 2015). Beyond access issues-an oft cited statistic suggests that up to 65% of children and adolescents with serious mental health problems never access the mental health service system (Agency for Healthcare Research and Quality, 2010), and 60% of youth who initially engage in treatment drop out prematurely (Gopalan et al, 2010), RSTs are not commonly available in real-world community mental health settings (Marques et al, 2016).…”

“…Adapting RSTs are proposed to enhance the flexibility of the intervention; align it with the context, setting, and populations being served; and, as modifications often occur by providers, enhance providers’ decisions about client care. Adaptations may be made to the intervention’s content by removing or augmenting the intervention with additional information such as culturally specific content and other therapeutic techniques like mindfulness, adjusting the structure, be it the number of sessions or who is included in treatment, and the process of the RST, such as altering the sequencing of sessions (Aarons et al, 2012; Lau et al, 2017; Park et al, 2018; Saxe, Heidi Ellis, Fogler, & Navalta, 2012).…”