Publications by authors named "Sarah Kate Bearman"

36 Publications

Evaluating a Modular Approach to Therapy for Children With Anxiety, Depression, Trauma, or Conduct Problems (MATCH) in School-Based Mental Health Care: Study Protocol for a Randomized Controlled Trial.

Front Psychol 2021 5;12:639493. Epub 2021 Mar 5.

Department of Psychology, Harvard University, Cambridge, MA, United States.

Schools have become a primary setting for providing mental health care to youths in the U.S. School-based interventions have proliferated, but their effects on mental health and academic outcomes remain understudied. In this study we will implement and evaluate the effects of a flexible multidiagnostic treatment called Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH) on students' mental health and academic outcomes. This is an assessor-blind randomized controlled effectiveness trial conducted across five school districts. School clinicians are randomized to either MATCH or usual care (UC) treatment conditions. The target sample includes 168 youths (ages 7-14) referred for mental health services and presenting with elevated symptoms of anxiety, depression, trauma, and/or conduct problems. Clinicians randomly assigned to MATCH or UC treat the youths who are assigned to them through normal school referral procedures. The project will evaluate the effectiveness of MATCH compared to UC on youths' mental health and school related outcomes and assess whether changes in school outcomes are mediated by changes in youth mental health. This study was approved by the Harvard University Institutional Review Board (IRB14-3365). We plan to publish the findings in peer-reviewed journals and present them at academic conferences. ClinicalTrials.gov ID: NCT02877875. Registered on August 24, 2016.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpsyg.2021.639493DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973266PMC
March 2021

Sensing everyday activity: Parent perceptions and feasibility.

Infant Behav Dev 2021 Feb 16;62:101511. Epub 2021 Jan 16.

Department of Psychology, University of Texas at Austin, United States.

Mobile and wearable sensors provide a unique opportunity to capture the daily activities and interactions that shape developmental trajectories, with potential to revolutionize the study of development (de Barbaro, 2019). However, developmental research employing sensors is still in its infancy, and parents' comfort using these devices is uncertain. This exploratory report assesses parent willingness to participate in sensor studies via a nationally representative survey (N = 210) and live recruitment of a low-income, minority population for an ongoing study (N = 359). The survey allowed us to assess how protocol design influences acceptability, including various options for devices and datastream resolution, conditions of data sharing, and feedback. By contrast, our recruitment data provided insight into parents' true willingness to participate in a sensor study, with a protocol including 72 h of continuous audio, motion, and physiological data. Our results indicate that parents are relatively conservative when considering participation in sensing studies. However, nearly 41 % of surveyed parents reported that they would be at least somewhat willing to participate in studies with audio or video recordings, 26 % were willing or extremely willing, and 14 % reported being extremely willing. These results roughly paralleled our recruitment results, where 58 % of parents indicated interest, 29 % of parents scheduled to participate, and 10 % ultimately participated. Additionally, 70 % of caregivers stated their reason for not participating in the study was due to barriers unrelated to sensing while about 25 % noted barriers due to either privacy concerns or the physical sensors themselves. Parents' willingness to collect sensitive datastreams increased if data stayed within the household for individual use only, are shared anonymously with researchers, or if parents receive feedback from devices. Overall, our findings suggest that given the correct circumstances, mobile sensors are a feasible and promising tool for characterizing children's daily interactions and their role in development.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.infbeh.2020.101511DOI Listing
February 2021

Clinician training, then what? Randomized clinical trial of child STEPs psychotherapy using lower-cost implementation supports with versus without expert consultation.

J Consult Clin Psychol 2020 Dec;88(12):1065-1078

Department of Psychology, Harvard University.

Objective: Implementation of evidence-based treatments in funded trials is often supported by expert case consultation for clinicians; this may be financially and logistically difficult in clinical practice. Might less costly implementation support produce acceptable treatment fidelity and clinical outcomes?

Method: To find out, we trained 42 community clinicians from four community clinics in Modular Approach to Therapy for Children (MATCH), then randomly assigned them to receive multiple lower-cost implementation supports (LC) or expert MATCH consultation plus lower-cost supports (CLC). Clinically referred youths (N = 200; ages 7-15 years, M = 10.73; 53.5% male; 32.5% White, 27.5% Black, 24.0% Latinx, 1.0% Asian, 13.5% multiracial, 1.5% other) were randomly assigned to LC (n = 101) or CLC (n = 99) clinicians, and groups were compared on MATCH adherence and competence, as well as on multiple clinical outcomes using standardized measures (e.g., Child Behavior Checklist, Youth Self-Report) and idiographic problem ratings (Top Problems Assessment).

Results: Coding of therapy sessions revealed substantial therapist adherence to MATCH in both conditions, with significantly stronger adherence in CLC; however, LC and CLC did not differ significantly in MATCH competence. Trajectories of change on all outcome measures were steep, positive, and highly similar for LC and CLC youths, with no significant differences; a supplemental analysis of posttreatment outcomes also showed similar LC and CLC posttreatment scores, with most LC-CLC differences nonsignificant.

Conclusions: The findings suggest that effective implementation of a complex intervention in clinical practice may be supported by procedures that are less costly and logistically challenging than expert consultation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/ccp0000536DOI Listing
December 2020

After the Study Ends: A Qualitative Study of Factors Influencing Intervention Sustainability.

Prof Psychol Res Pr 2020 Apr 18;51(2):134-144. Epub 2019 Jul 18.

Harvard University.

Sustaining evidence-based practices after initial training and support has ended is necessary to ensure lasting improvements in youth mental health services. This study examined factors impacting community clinicians' decisions to sustain a transdiagnostic youth intervention following participation in a study. The aim of the study was to identify potentially mutable factors impacting sustainability to inform future implementation efforts. Thirteen clinicians (85% women, 92% Caucasian, age = 35.6) completed interviews after participating in an open trial of an evidence-based intervention for depression, anxiety, and conduct disorders. Interviews were analyzed using thematic analysis methods. All (100%) clinicians reported current use of the intervention. Four themes emerged related to sustainability. Clinicians (100%) reported that making modifications, alignment with prior training, and relative advantage influenced their current intervention use. Clinicians (100%) reported that knowledge transfer from treatment developers was vital to sustainability. They (92%) noted a number of logistical, inner-organizational, and client-level barriers to sustainability. Lastly, clinicians (92%) identified factors related to scaling up the intervention. A variety of personal, organizational, logistical, and client variables influence the sustainment of new interventions, and could be leveraged in future implementation efforts.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/pro0000258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518310PMC
April 2020

Introducing a Measurement Feedback System for Youth Mental Health: Predictors and Impact of Implementation in a Community Agency.

Adm Policy Ment Health 2021 03;48(2):327-342

Department of Educational Psychology, The University of Texas At Austin, 504 SZB, 1 University Station, D5800, Austin, TX, 78712-0383, USA.

Measurement feedback systems (MFSs) that routinely collect and report client progress to mental health therapists have demonstrated beneficial impact on outcomes in numerous studies, with evidence that there is a dose-response relationship related to the implementation of the MFS. The current study examined the impact of MFS implementation (Implementation Index) on youth symptom outcomes separately by caregiver and youth self-report. Additionally, we tested the extent to which Implementation Index rates varied by individual therapists and clients, and whether therapist and client characteristics predicted MFS implementation. Methods: Administrative data (client charts, youth- and caregiver-reported Youth Outcome Questionnaires) for 229 youth (52.83% Latinx, 42.79% girls, M age = 10.33) treated during a 1-year period at a community mental health organization in Central Texas were analyzed using multi-level modeling. Caregiver-reported symptoms decreased faster for those with a higher MFS Implementation Index. Between-group differences among therapists accounted for a significant proportion of variance in the Implementation Index for caregiver report, whereas client differences accounted for most of the variance in the Implementation Index for youth self-report. Therapist trainee status predicted a significant increase in the Implementation Index for caregiver-report data. Youth symptom improvement as reported by caregivers varied with the extent of MFS implementation fidelity, and MFS implementation fidelity was higher for clients treated by trainees relative to staff therapists for caregiver report of symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10488-020-01076-5DOI Listing
March 2021

Effect of Clinician Training in the Modular Approach to Therapy for Children vs Usual Care on Clinical Outcomes and Use of Empirically Supported Treatments: A Randomized Clinical Trial.

JAMA Netw Open 2020 08 3;3(8):e2011799. Epub 2020 Aug 3.

Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.

Importance: The Modular Approach to Therapy for Children (MATCH) was developed to address the comorbidities common among clinically referred youth, with beneficial outcomes shown in 2 US randomized clinical trials, where it outperformed both usual clinical care and single disorder-specific treatments.

Objective: To determine whether MATCH training of clinicians would result in more use of empirically supported treatment (EST) and better clinical outcomes than usual care (UC) in the publicly funded, multidisciplinary context of New Zealand.

Design, Setting, And Participants: This multisite, single-blind, computer-randomized clinical effectiveness trial compared MATCH with UC in child and adolescent mental health services in 5 regions of New Zealand. Recruitment occurred from March 2014 to July 2015, and a 3-month follow-up assessment was completed by May 2016. Clinicians at participating child and adolescent mental health services were randomized (1:1) to undertake training in MATCH or to deliver UC, and young people with anxiety, depression, trauma-related symptoms, or disruptive behavior seeking treatment at child and adolescent mental health services were randomized (1:1) to receive MATCH or UC. Participants and research assistants were blind to allocation. Data analysis was performed from April 2016 to July 2017.

Interventions: MATCH comprises EST components for flexible management of common mental health problems. UC includes case management and psychological therapies. Both can include pharmacotherapy.

Main Outcomes And Measures: There were 3 primary outcomes: trajectory of change of clinical severity, as measured by weekly ratings on the Brief Problem Monitor (BPM); fidelity to EST content, as measured by audio recordings of therapy sessions coded using the Therapy Integrity in Evidence Based Interventions: Observational Coding System; and efficiency of service delivery, as measured by duration of therapy (days) and clinician time (minutes).

Results: The study included 65 clinicians (mean age, 38.7 years; range, 23.0-64.0 years; 54 female [83%]; MATCH, 32 clinicians; UC, 33 clinicians) and 206 young people (mean age, 11.2 years; range 7.0-14.0 years; 122 female [61%]; MATCH, 102 patients; UC, 104 patients). For the BPM total ratings for parents, there was a mean (SE) slope of -1.04 (0.14) (1-year change, -6.12) in the MATCH group vs -1.04 (0.10) (1-year change, -6.17) in the UC group (effect size, 0.00; 95% CI, -0.27 to 0.28; P = .96). For the BPM total for youths, the mean (SE) slope was -0.74 (0.15) (1-year change, -4.35) in the MATCH group vs -0.73 (0.10) (1-year change, -4.32) in the UC group (effect size, -0.02; 95% CI, -0.30 to 0.26; P = .97). Primary analyses (intention-to-treat) showed no difference in clinical outcomes or efficiency despite significantly higher fidelity to EST content in the MATCH group (58 coded sessions; mean [SD], 80.0% [20.0%]) than the UC group (51 coded sessions; mean [SD], 57.0% [32.0%]; F(1,108) = 23.0; P < .001). With regard to efficiency of service delivery, there were no differences in total face-to-face clinician time between the MATCH group (mean [SD], 806 [527] minutes) and the UC group (mean [SD], 677 [539] minutes) or the overall duration of therapy between the MATCH group (mean [SD], 167 [107 days]) and the UC group (mean [SD], 159 [107] days).

Conclusions And Relevance: MATCH significantly increased adherence to EST practices but did not improve outcomes or efficiency. The nonsuperiority of MATCH may be attributable to high levels of EST use in UC in New Zealand.

Trial Registration: Australian New Zealand Clinical Trials Registry Identifier: ACTRN12614000297628.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamanetworkopen.2020.11799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431993PMC
August 2020

Pediatric Consultation-Liaison: Patient Characteristics and Considerations for Training in Evidence-Based Practices.

J Clin Psychol Med Settings 2020 Aug 10. Epub 2020 Aug 10.

PracticeWise, LLC, Satellite Beach, FL, USA.

Consultation-liaison services are an integral part of many pediatric hospital settings, yet characteristics of this patient population have not been extensively documented. The current study is a retrospective one-year chart review of the consultation-liaison service at a large pediatric hospital in the Southwestern United States. The purpose of this study is twofold: (1) to characterize this hospital's CL population and (2) to use these characteristics to identify preliminary evidence-based practices that should be considered for CL provider training. Identifying evidence-based practice elements that align with the characteristics of consultation-liaison patient populations may inform trainings for consultation-liaison staff. This would help to ensure that youth seen in hospital consultation-liaison services are getting the best available services, which is critical given the shortened time frame available to work with this patient population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10880-020-09738-0DOI Listing
August 2020

A Second and Third Look at FIRST: Testing Adaptations of A Principle-Guided Youth Psychotherapy.

J Clin Child Adolesc Psychol 2020 Aug 7:1-14. Epub 2020 Aug 7.

Department of Psychological Sciences, University of Missouri.

Objective: We examined the acceptability, integrity, and symptom trajectories associated with FIRST, a principle-guided treatment for youth internalizing and externalizing problems designed to support efficient uptake and implementation.

Method: We conducted two open trials of an adapted FIRST, focusing on uptake and implementation by novice trainees in a university-affiliated clinic, limiting treatment duration to six sessions, and benchmarking findings against a 2017 FIRST trial with community therapists. In Study 1, trainees received a two-day training and weekly two-hour supervision ( = 22 youths, ages 7-17, 50% female, 54.54% Caucasian, 4.55% Latinx). In Study 2, trainees received a one-day training and weekly one-hour supervision, delivering the six-session FIRST in a predetermined sequence ( = 26 youths, ages 11-17, 42.31% female, 65.38% Caucasian, 7.69% Latinx). In Study 3, the original study therapists - now practitioners - evaluated FIRST's effectiveness and implementation difficulty, and reported their own post-study FIRST use.

Results: Acceptability (treatment completion, session attendance, caregiver participation) and integrity (adherence, competence) were comparable across Study 1, Study 2 and the 2017 trial. Improvement effect sizes across ten outcome measures were in the large range in all three trials: ES = 1.10 in the 2017 trial, 0.83 in Study 1, and 0.81 in Study 2. Study 3 showed high effectiveness ratings, low difficulty ratings, and continued use of FIRST by a majority of clinicians.

Conclusions: Across two open trials and a follow-up survey, FIRST showed evidence of acceptability and integrity, with youth symptom reduction comparable to that in prior research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/15374416.2020.1796678DOI Listing
August 2020

Effects of standard and modular psychotherapies in the treatment of youth with severe irritability.

J Consult Clin Psychol 2020 Mar;88(3):255-268

Department of Psychology, University of California, Los Angeles.

Objective: To examine the preliminary effectiveness of a modular, transdiagnostic, behavioral/cognitive-behavioral intervention (MATCH) compared with standard manualized treatments (SMT) and usual care (UC) for treating youth with severe irritability.

Method: We analyzed data from an effectiveness trial in which treatment-referred youths ( = 174; = 10.6 years; 70% boys) were randomized to receive MATCH, SMT, or UC (s = 53-62). Masked assessments of irritability, diagnoses, impairment, and internalizing, externalizing, total, and top problems were collected from caregivers and youths at pre- and posttreatment, weekly during treatment, and quarterly through 2-year follow-up. Baseline measures of irritability and impairment were used to identify a subsample characterized by severe irritability and mood dysregulation (SIMD; = 81; = 10.2 years; 69% boys; s = 24-31 across conditions). Longitudinal multilevel models and ANOVAs were estimated to examine numerous clinical outcomes within and between conditions.

Results: Among youth with SIMD, MATCH produced faster improvements than UC and SMT, with medium or large effect sizes in two thirds of all comparisons tested ( ES = 0.60). Although SIMD youths in all conditions showed reductions in DSM diagnoses, only MATCH predicted significantly fewer posttreatment diagnoses than UC (averaging 1.0 fewer; ES = 0.93). Finally, among the entire sample, MATCH and SMT equivalently outperformed UC in reducing irritability (ES = 0.49) and the effects of each treatment condition on other outcomes were not moderated by baseline irritability.

Conclusions: Extant behavioral/cognitive-behavioral psychotherapies-already well-established and widely used-may be helpful for treating youths with severe irritability. A transdiagnostic, modular format showed the most consistently favorable pattern of results across multiple outcomes, informants, and measurement schedules. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/ccp0000456DOI Listing
March 2020

Testing Robustness of Child STEPs Effects with Children and Adolescents: A Randomized Controlled Effectiveness Trial.

J Clin Child Adolesc Psychol 2020 Nov-Dec;49(6):883-896. Epub 2019 Sep 13.

Department of Psychology, University of Miami.

A critical task in psychotherapy research is identifying the conditions within which treatment benefits can be replicated and outside of which those benefits are reduced. We tested the robustness of beneficial effects found in two previous trials of the modular Child STEPs treatment program for youth anxiety, depression, trauma, and conduct problems. We conducted a randomized trial, with two significant methodological changes from previous trials: (a) shifting from cluster- to person-level randomization, and (b) shifting from individual to more clinically feasible group-based consultation with STEPs therapists. Fifty community clinicians from multiple outpatient clinics were randomly assigned to receive training and consultation in STEPs (= 25) or to provide usual care (UC; = 25). There were 156 referred youths-ages 6-16 (= 10.52, = 2.53); 48.1% male; 79.5% Caucasian, 12.8% multiracial, 4.5% Black, 1.9% Latino, 1.3% Other-who were randomized to STEPs (= 77) or UC (= 79). Following previous STEPs trials, outcome measures included parent- and youth-reported internalizing, externalizing, total, and idiographic top problems, with repeated measures collected weekly during treatment and longer term over 2 years. Participants in both groups showed statistically significant improvement on all measures, leading to clinically meaningful problem reductions. However, in contrast to previous trials, STEPs was not superior to UC on measure. As with virtually all treatments, the benefits of STEPs may depend on the conditions-for example, of study design and implementation support-in which it is tested. Identifying those conditions may help guide appropriate use of STEPs, and other treatments, in the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/15374416.2019.1655757DOI Listing
February 2021

Assessing the Irritable and Defiant Dimensions of Youth Oppositional Behavior Using CBCL and YSR Items.

J Clin Child Adolesc Psychol 2020 Nov-Dec;49(6):804-819. Epub 2019 Jul 5.

Department of Psychology, Harvard University.

Research suggests that irritability and defiance are distinct dimensions of youth oppositionality that are differentially associated with internalizing and conduct problems, respectively. Because much of this evidence has emerged with limited psychometric evaluation, we conducted the first multi-informant examination of selected Child Behavior Checklist (CBCL) and Youth Self Report (YSR) items for measuring irritability and defiance in a large clinical sample. Clinically referred youths ( = 1,030; ages 6-15; 43% female, 42% ethnic minority) were assessed prior to treatment using multi-informant rating scales and diagnostic interviews. Analyses examined factor structure, invariance, internal consistency, multi-informant patterns, and convergent, discriminant, and criterion validity with internalizing and externalizing problems/disorders. A correlated 2-factor model of irritability (stubborn/sullen/irritable, mood, temper) and defiance (argues, disobeys-home, disobeys-school) fit well for both informants. Adequate measurement invariance and scale consistency was consistently found for parent-report but not youth-report. With both informants, all hypothesized convergent and discriminant validity associations were supported: irritability and defiance with internalizing and conduct scales, respectively. However, hypothesized criterion validity associations were largely found only by parent-report: irritability with anxiety and depressive disorders, defiance with conduct disorder, and both with oppositional defiant disorder. Results consistently supported the reliability and validity of the CBCL irritability and defiance scales, with somewhat less consistent support for the YSR scales. Thus, CBCL items may provide psychometrically sound assessment of irritability and defiance, whereas further research is needed to advance youth-report and multi-informant strategies. Results also provide further support for a two subdimension model of oppositional defiant disorder symptoms that includes irritability and defiance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/15374416.2019.1622119DOI Listing
February 2021

Evaluating Modular Approach to Therapy for Children with Anxiety, Depression, Trauma and Conduct Problems (MATCH-ADCT) in Norwegian child and adolescent outpatient clinics: Study protocol for a randomized controlled trial.

Trials 2019 Jan 7;20(1):16. Epub 2019 Jan 7.

Department of Psychology, Faculty of Arts and Sciences, Harvard University, 1030 William James Hall, 33 Kirkland Street, Cambridge, MA, 02138, USA.

Background: Norwegian health, care, and welfare services are experiencing increased demands to deliver services that are safe, effective, of high quality, and that ensure user involvement. Yet, evidence-based treatment for common disorders such as depression, anxiety, trauma, and behavioral problems in children are not regularly used in clinical practice in Norway. Possible explanations for this are that many standard, evidence-based treatments may have difficulty addressing the complexity and comorbidity of referred children and the fact that children's treatment needs often shift during treatment. The Modular Approach to Therapy for children with Anxiety, Depression, Trauma and Conduct problems (MATCH-ADTC) was designed to address these challenges and reduce some of the barriers to therapists' use of evidence-based treatment in their practice.

Methods/design: Participants will include 280 children (aged 6-14.5 years at intake) who receive treatment in child and adolescent mental health outpatient clinics in Norway, and their families. Families are randomly assigned to either the experimental group receiving treatment from therapists trained in MATCH, or to the comparison group receiving treatment from therapists delivering treatment as usual (TAU). Data on children's symptomology, child and family functioning, demographics, background information, and mental health outcomes are collected as well as frequent feedback on treatment response, plus video-recordings of treatment sessions and implementation quality scores from each participating clinic. Questionnaires are administered in six waves.

Discussion: MATCH has been tested in the US with promising results, but we do not know whether this treatment approach will produce similar results in Norway. The implications of this study are 1. Possibly better treatment outcomes and/or more efficient improvements for children and families treated in mental health outpatient clinics in Norway 2. Clinicians learning to use more evidence-based practices in their treatment 3. Implementation of standard procedures for obtaining feedback from children and families and sharing the feedback with clinicians 4. Increased understanding, at the end of the trial, of whether introducing MATCH improves outcomes for children and families treated in mental health outpatient clinics TRIAL REGISTRATION: ISRCTN, registration number: ISRCTN24029895 . Registered on 8 August 2016.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13063-018-3074-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322284PMC
January 2019

When the torch is passed, does the flame still burn? Testing a "train the supervisor" model for the Child STEPs treatment program.

J Consult Clin Psychol 2018 Sep;86(9):726-737

Department of Psychology, University of Miami.

Objective: We assessed sustainability of an empirically supported, transdiagnostic youth psychotherapy program when therapist supervision was shifted from external experts to internal clinic staff.

Method: One hundred sixty-eight youths, aged 6-15 years, 59.5% male, 85.1% Caucasian, were treated for anxiety, depression, traumatic stress, or conduct problems by clinicians employed in community mental health clinics. In Phase 1 (2.7 years), 1 group of clinicians, the Sustain group, received training in Child STEPs (a modular transdiagnostic treatment + weekly feedback on youth response) and treated clinic-referred youths, guided by weekly supervision from external STEPs experts. In Phase 2 (2.9 years), Sustain clinicians treated additional youths but with supervision by clinic staff who had been trained to supervise STEPs. Also in Phase 2, a new group, External Supervision clinicians, received training and supervision from external STEPs experts and treated referred youths. Phase 2 youths were randomized to Sustain or External Supervision clinicians. Groups were compared on 3 therapist fidelity measures and 14 clinical outcome measures.

Results: Sustain clinicians maintained their previous levels of fidelity and youth outcomes after switching from external to internal supervision; and in Phase 2, the Sustain and External Supervision groups also did not differ on fidelity or youth outcomes. Whereas all 34 group comparisons were nonsignificant, trends with the largest effect sizes showed better clinical outcomes for internal than external supervision.

Conclusions: Implementation of empirically supported transdiagnostic treatment may be sustained when supervision is transferred from external experts to trained clinic staff, potentially enhancing cost-effectiveness and staying power in clinical practice. (PsycINFO Database Record
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/ccp0000331DOI Listing
September 2018

Clinical Supervision of Mental Health Professionals Serving Youth: Format and Microskills.

Adm Policy Ment Health 2018 09;45(5):800-812

Department of Educational Psychology, The University of Texas at Austin, 504 SZB, 1 University Station, D5800, Austin, TX, 78712-0383, USA.

Clinical supervision is an element of quality assurance in routine mental health care settings serving children; however, there is limited scientific evaluation of its components. This study examines the format and microskills of routine supervision. Supervisors (n = 13) and supervisees (n = 20) reported on 100 supervision sessions, and trained coders completed observational coding on a subset of recorded sessions (n = 57). Results indicate that microskills shown to enhance supervisee competency in effectiveness trials and experiments were largely absent from routine supervision, highlighting potential missed opportunities to impart knowledge to therapists. Findings suggest areas for quality improvement within routine care settings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10488-018-0865-yDOI Listing
September 2018

A Preliminary Exploration of the Barriers to Delivering (and Receiving) Exposure-Based Cognitive Behavioral Therapy for Anxiety Disorders in Adult Community Mental Health Settings.

Community Ment Health J 2018 10 9;54(7):899-911. Epub 2018 Mar 9.

Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, USA.

Despite the effectiveness of exposure-based cognitive behavioral therapy (CBT) for anxiety disorders, few individuals in need receive this treatment, particularly in community mental health settings serving low-income adults. The present study took a preliminary step to understand these barriers by conducting a series of key informant interviews and focus groups among patients, providers, clinical administrators, and policy makers. Several themes emerged as barriers to the delivery of exposure-based CBT in these settings, including therapist training and compentency issues, logistical issues, and funding stream issues. Clinical implications and future research that can build from these data are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10597-018-0252-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129437PMC
October 2018

Stakeholder Perceptions of the Barriers to Receiving and Delivering Exposure-Based Cognitive Behavioral Therapy for Anxiety Disorders in Adult Community Mental Health Settings.

Community Ment Health J 2019 01 5;55(1):83-99. Epub 2018 Mar 5.

Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA.

CBT is considered the first-line treatment for anxiety disorders, particularly when it involves gradual confrontation with feared stimuli (i.e., exposure); however, delivery of CBT for anxiety disorders in real-world community clinics is lacking. This study utilized surveys we developed with key stakeholder feedback (patient, provider, and administrator) to assess patient and provider/administrator perceptions of the barriers to delivering (or receiving) CBT for anxiety disorders. Providers/administrators from two counties in California (N = 106) indicated lack of training/competency as primary barriers. Patients in one large county (N = 42) reported their own symptoms most often impacted treatment receipt. Both groups endorsed acceptability of exposure but indicated that its use in treatment provided/received had been limited. Implications and recommendations are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10597-018-0250-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123294PMC
January 2019

Physician perceptions of children's coping with asthma are associated with children's psychosocial and disease functioning.

Fam Syst Health 2018 09 27;36(3):327-337. Epub 2017 Nov 27.

Departments of Psychiatry and Surgery, University of Illinois at Chicago.

Introduction: Low-income, ethnic minority children disproportionately face poor asthma control, and poorly controlled asthma is related to psychosocial difficulties. This study assessed physician reports of coping in child patients and examined associations between physician reports of child coping and parent and child reports of children's coping, psychosocial, and asthma outcomes (asthma-related stress, emotional and behavioral problems, asthma control, and school missed due to asthma).

Method: Physicians reported on coping in their patients (N = 67) ages 5-17 with asthma. Parents reported on child coping, asthma-related stress, emotional and behavioral problems, asthma control, and school missed due to asthma. Children ages 9-17 provided self-reports.

Results: Physicians' reports of primary control coping (e.g., problem solving) and secondary control coping (e.g., cognitive restructuring) were not associated with parent ratings of corresponding coping strategies, but physician reports of disengagement coping (e.g., avoidance) were correlated with parent reports of disengagement and secondary control coping. Physician perceptions of higher child primary control, and lower disengagement, were correlated with less parent-reported stress, better asthma control, and for primary control, fewer partial days of school missed. Physician reports were not correlated with child reports of coping, but physician reports of disengagement were correlated with child-reported conduct problems.

Discussion: Findings suggest that physician reports of child coping provide independent information from parent and child reports of coping, and could be leveraged to identify and intervene with patients who are at elevated risk for poor outcomes. (PsycINFO Database Record
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/fsh0000299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078809PMC
September 2018

Initial Test of a Principle-Guided Approach to Transdiagnostic Psychotherapy With Children and Adolescents.

J Clin Child Adolesc Psychol 2017 Jan-Feb;46(1):44-58. Epub 2016 Jul 21.

c Department of Psychology , University of Miami.

To address implementation challenges faced by some evidence-based youth psychotherapies, we developed an efficient transdiagnostic approach-a potential "first course" in evidence-based treatment (EBP)-guided by five empirically supported principles of therapeutic change. An open trial of the resulting FIRST protocol was conducted in community clinics. Following a 2-day training, staff practitioners treated 24 clinically referred youths ages 7-15, 50% male, 87% White and 13% Latino, all with the Schedule for Affective Disorders and Schizophrenia for School-Age Children Diagnostic and Statistical Manual of Mental Disorders (4th ed.) anxiety, depressive, or conduct-related disorders, and averaging 2.21 disorders. We evaluated the protocol's (a) feasibility for use in everyday clinical practice (examining therapy process, client engagement, and therapist adherence and competence in using the protocol), (b) acceptability (examining therapeutic alliance and treatment satisfaction by youths, caregivers, and therapists), and (c) potential for clinical benefit (examining treatment outcomes across multiple measures and time points). FIRST scored well on measures of feasibility, acceptability to clients and clinicians, and clinical outcomes, matching or exceeding the corresponding scores in most benchmarking comparisons. Observational coding of sessions showed high levels of protocol adherence (86.6%) and good therapist competence in the evidence-based skills. 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 FIRST protocol showed evidence of feasibility, acceptability, and clinical benefit when used by practitioners with referred youths treated in community clinics. The findings suggest sufficient potential to justify a full randomized controlled trial of FIRST.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/15374416.2016.1163708DOI Listing
July 2017

Building an Evidence Base for Effective Supervision Practices: An Analogue Experiment of Supervision to Increase EBT Fidelity.

Adm Policy Ment Health 2017 Mar;44(2):293-307

Ferkauf Graduate School of Psychology, Department of School-Clinical Child Psychology, Yeshiva University, New York, USA.

Treatments that are efficacious in research trials perform less well under routine conditions; differences in supervision may be one contributing factor. This study compared the effect of supervision using active learning techniques (e.g. role play, corrective feedback) versus "supervision as usual" on therapist cognitive restructuring fidelity, overall CBT competence, and CBT expertise. Forty therapist trainees attended a training workshop and were randomized to supervision condition. Outcomes were assessed using behavioral rehearsals pre- and immediately post-training, and after three supervision meetings. EBT knowledge, attitudes, and fidelity improved for all participants post-training, but only the SUP+ group demonstrated improvement following supervision.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10488-016-0723-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6656533PMC
March 2017

Modular Approach to Therapy for Anxiety, Depression, Trauma, or Conduct Problems in outpatient child and adolescent mental health services in New Zealand: study protocol for a randomized controlled trial.

Trials 2015 Oct 12;16:457. Epub 2015 Oct 12.

Department of Psychological Medicine, School of Medicine, Level 12 Auckland City Hospital Support Building, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.

Background: Mental health disorders are common and disabling for young people because of the potential to disrupt key developmental tasks. Implementation of evidence-based psychosocial therapies in New Zealand is limited, owing to the inaccessibility, length, and cost of training in these therapies. Furthermore, most therapies address one problem area at a time, although comorbidity and changing clinical needs commonly occur in practice. A more flexible approach is needed. The Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH-ADTC) is designed to overcome these challenges; it provides a range of treatment modules addressing different problems, within a single training program. A clinical trial of MATCH-ADTC in the USA showed that MATCH-ADTC outperformed usual care and standard evidence-based treatment on several clinical measures. We aim to replicate these findings and evaluate the impact of providing training and supervision in MATCH-ADTC to: (1) improve clinical outcomes for youth attending mental health services; (2) increase the amount of evidence-based therapy content; (3) increase the efficiency of service delivery.

Methods: This is an assessor-blinded multi-site effectiveness randomized controlled trial. Randomization occurs at two levels: (1) clinicians (≥60) are randomized to intervention or usual care; (2) youth participants (7-14 years old) accepted for treatment in child and adolescent mental health services (with a primary disorder that includes anxiety, depression, trauma-related symptoms, or disruptive behavior) are randomly allocated to receive MATCH-ADTC or usual care. Youth participants are recruited from 'mainstream', Māori-specific, and Pacific-specific child and adolescent mental health services. We originally planned to recruit 400 youth participants, but this has been revised to 200 participants. Centralized computer randomization ensures allocation concealment. The primary outcome measures are: (i) the difference in trajectory of change of clinical severity between groups (using the parent-rated Brief Problem Monitor); (ii) clinicians' use of evidence-based treatment procedures during therapy sessions; (iii) total time spent by clinicians delivering therapy.

Discussion: If MATCH-ADTC demonstrates effectiveness it could offer a practical efficient method to increase access to evidence-based therapies, and improve outcomes for youth attending secondary care services.

Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12614000297628 .
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13063-015-0982-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603305PMC
October 2015

Review: Comprehensive treatments for youth comorbidity - evidence-guided approaches to a complicated problem.

Child Adolesc Ment Health 2015 Sep 27;20(3):131-141. Epub 2015 Mar 27.

Department of Psychology, Harvard University, Boston, MA, USA.

Background: Evidence-based treatments (EBTs) with a single-disorder focus have improved the potential for youth mental health care, yet may be an imperfect fit to clinical care settings where diagnostic comorbidity and co-occurring problems are commonplace. Most EBTs were developed to treat one diagnosis or problem (or a small homogenous cluster), but most clinically referred youths present with multiple disorders and problems.

Findings: Three emerging approaches may help address the comorbidity that is so common in treated youths. Conceptually unified treatments target presumed causal and maintaining factors that are shared among more than one disorder or problem area; preliminary open trials and case studies show promising results. Modular protocols combine the 'practice elements' that commonly appear in separate single-disorder EBTs and repackage them into coordinated delivery systems; one modular protocol, MATCH, has produced positive findings in a randomized effectiveness trial. Monitoring and Feedback Systems (MFSs) provide real-time data on client progress to inform clinical decision-making, encompassing comorbid and co-occurring problems; one study shows beneficial effects in everyday practice with diverse youth problems.

Conclusions: All three approaches - conceptually unified, modular, and MFS - can be strengthened by increased research attention to treatment integrity, clinician user-appeal, design simplicity, and the infrastructure necessary for successful implementation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/camh.12092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4574497PMC
September 2015

Pre-Practicum Training in Professional Psychology to Close the Research-Practice Gap: Changing Attitudes Towards Evidence-Based Practice.

Train Educ Prof Psychol 2015 Feb;9(1):13-20

Ferkauf Graduate School of Psychology, Department of School-Clinical Child Psychology, Yeshiva University.

Despite the rapid proliferation of mental health interventions with proven benefit for youth, empirically supported interventions (ESIs) are underutilized in most service settings. Treatment outcome studies in these community-based settings suggest that the majority of youth do not show improvement, underscoring the importance of addressing the gap between research and practice. Clinician attitudes toward evidence-based practice (EBP) may limit the use of ESIs, and efforts to address these attitudes with post-graduate training pose significant challenges. Pre-practicum training in EBP may address these challenges by familiarizing students with the framework of EBP as well as with the current youth treatment evidence base and the theories and strategies of well-supported interventions. We describe a required EBP course within a professional psychology doctoral program. Forty-two students in two class cohorts completed a measure of attitudes toward EBP prior to the first class and after the final class lecture. Students were predominantly Caucasian women with bachelor's degrees. As expected, over the course of the class, student attitudes became significantly more favorable toward EBP. Students who had previously received a master's degree had more favorable attitudes prior to the class, and students with a prior bachelor's degree showed the greatest change in attitude. The results support the use of pre-practicum training in EBP to improve attitudes toward EBP, which may lead to use of effective practices with clients following training.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/tep0000052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346208PMC
February 2015

From Practice to Evidence in Child Welfare: Model Specification and Fidelity Measurement of Team Decisionmaking.

Child Youth Serv Rev 2014 Apr;39:153-159

Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences.

Fidelity measurement methods have traditionally been used to develop and evaluate the effects of psychosocial treatments and, more recently, their implementation in practice. The fidelity measurement process can also be used to operationally define and specify components of emerging but untested practices outside the realm of conventional treatment. Achieving optimal fidelity measurement effectiveness (scientific validity and reliability) and efficiency (feasibility and relevance in routine care contexts) is challenging. The purpose of this paper is to identify strategies to address these challenges in child welfare system practices. To illustrate the challenges, and operational steps to address them, we present a case example using the "Team Decisionmaking" (TDM; Annie E. Casey Foundation) intervention. This intervention has potential utility for decreasing initial entry into and time spent in foster care and increasing rates of reunification and relative care. While promising, the model requires rigorous research to refine knowledge regarding the relationship between intervention components and outcomes-research that requires fidelity measurement. The intent of this paper is to illustrate how potentially generalizable steps for developing effective and efficient fidelity measurement methods can be used to more clearly define and test the effects of child welfare system practices.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.childyouth.2013.10.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4205920PMC
April 2014

More practice, less preach? the role of supervision processes and therapist characteristics in EBP implementation.

Adm Policy Ment Health 2013 Nov;40(6):518-29

Department of School-Clinical Child Psychology, Ferkauf Graduate School of Psychology, Yeshiva University, Rousso Building, 1300 Morris Park Avenue, Bronx, NY, 10461, USA,

Identifying predictors of evidence-based practice (EBP) use, such as supervision processes and therapist characteristics, may support dissemination. Therapists (N = 57) received training and supervision in EBPs to treat community-based youth (N = 136). Supervision involving modeling and role-play predicted higher overall practice use than supervision involving discussion, and modeling predicted practice use in the next therapy session. No therapist characteristics predicted practice use, but therapist sex and age moderated the supervision and practice use relation. Supervision involving discussion predicted practice use for male therapists only, and modeling and role-play in supervision predicted practice use for older, not younger, therapists.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10488-013-0485-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4083565PMC
November 2013

Tracking evidence based practice with youth: validity of the MATCH and standard manual consultation records.

J Clin Child Adolesc Psychol 2013 18;42(1):44-55. Epub 2012 Jul 18.

Department of Psychology, University of California, Los Angeles, CA 90095, USA.

This study sought to evaluate the agreement between therapist report and coder observation of therapy practices. The study sampled session data from a community-based, randomized trial of treatment for youth ages 7 to 13. We used therapist report of session content and coverage gathered using formal Consultation Records and developed complimentary records for coders to use when watching or listening to therapy tape. We established initial reliability between coders and then conducted a random, stratified, and comprehensive sample of sessions across youth (N = 121), therapists (N = 57), conditions (MATCH and Standard Manuals), and study sites (Honolulu and Boston) to code and compare with therapist record reports. Intraclass correlation coefficients (ICCs) representing coder versus therapist agreement on manual content delivered ranged from .42 to 1.0 across conditions and problem areas. Analyses revealed marked variability in agreement regarding whether behavioral rehearsals took place (ICCs from -.01 to 1.0) but strong agreement on client comprehension of therapy content and homework assignments. Overall, the findings indicate that therapists can be accurate reporters of the therapeutic practices they deliver, although they may need more support in reporting subtle but valuable aspects of implementation such as types of behavioral rehearsals. Developing means to support accurate reporting is important to developing future clinical feedback methodology applicable to the implementation of evidence-based treatments in the real world.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/15374416.2012.700505DOI Listing
June 2013

Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: a randomized effectiveness trial.

Arch Gen Psychiatry 2012 Mar 7;69(3):274-82. Epub 2011 Nov 7.

Department of Psychology, Harvard University, Cambridge, MA 02138, USA.

Context: Decades of randomized controlled trials have produced separate evidence-based treatments for depression, anxiety, and conduct problems in youth, but these treatments are not often used in clinical practice, and they produce mixed results in trials with the comorbid, complex youths seen in practice. An integrative, modular redesign may help.

Objective: Standard/separate and modular/integrated arrangements of evidence-based treatments for depression, anxiety, and conduct problems in youth were compared with usual care treatment, with the modular design permitting a multidisorder focus and a flexible application of treatment procedures.

Design: Randomized effectiveness trial.

Setting: Ten outpatient clinical service organizations in Massachusetts and Hawaii.

Participants: A total of 84 community clinicians were randomly assigned to 1 of 3 conditions for the treatment of 174 clinically referred youths who were 7 to 13 years of age (70% of these youths were boys, and 45% were white). The study was conducted during the period from January 12, 2005 to May 8, 2009.

Interventions: Standard manual treatment (59 youths [34% of the sample]; cognitive behavioral therapy for depression, cognitive behavioral therapy for anxiety, and behavioral parent training for conduct problems), modular treatment (62 youths [36%]; integrating the procedures of the 3 separate treatments), and usual care (53 youths [30%]).

Main Outcome Measures: Outcomes were assessed using weekly youth and parent assessments. These assessments relied on a standardized Brief Problem Checklist and a patient-generated Top Problems Assessment (ie, the severity ratings on the problems that the youths and parents had identified as most important). We also conducted a standardized diagnostic assessment before and after treatment.

Results: Mixed effects regression analyses showed that modular treatment produced significantly steeper trajectories of improvement than usual care and standard treatment on multiple Brief Problem Checklist and Top Problems Assessment measures. Youths receiving modular treatment also had significantly fewer diagnoses than youths receiving usual care after treatment. In contrast, outcomes of standard manual treatment did not differ significantly from outcomes of usual care.

Conclusions: The modular approach outperformed usual care and standard evidence-based treatments on multiple clinical outcome measures. The modular approach may be a promising way to build on the strengths of evidence-based treatments, improving their utility and effectiveness with referred youths in clinical practice settings. Trial Registration  clinicaltrials.gov Identifier: NCT01178554.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/archgenpsychiatry.2011.147DOI Listing
March 2012

Youth Top Problems: using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy.

J Consult Clin Psychol 2011 Jun;79(3):369-80

Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA.

Objective: To complement standardized measurement of symptoms, we developed and tested an efficient strategy for identifying (before treatment) and repeatedly assessing (during treatment) the problems identified as most important by caregivers and youths in psychotherapy.

Method: A total of 178 outpatient-referred youths, 7-13 years of age, and their caregivers separately identified the 3 problems of greatest concern to them at pretreatment and then rated the severity of those problems weekly during treatment. The Top Problems measure thus formed was evaluated for (a) whether it added to the information obtained through empirically derived standardized measures (e.g., the Child Behavior Checklist [CBCL; Achenbach & Rescorla, 2001] and the Youth Self-Report [YSR; Achenbach & Rescorla, 2001]) and (b) whether it met conventional psychometric standards.

Results: The problems identified were significant and clinically relevant; most matched CBCL/YSR items while adding specificity. The top problems also complemented the information yield of the CBCL/YSR; for example, for 41% of caregivers and 79% of youths, the identified top problems did not correspond to any items of any narrowband scales in the clinical range. Evidence on test-retest reliability, convergent and discriminant validity, sensitivity to change, slope reliability, and the association of Top Problems slopes with standardized measure slopes supported the psychometric strength of the measure.

Conclusions: The Top Problems measure appears to be a psychometrically sound, client-guided approach that complements empirically derived standardized assessment; the approach can help focus attention and treatment planning on the problems that youths and caregivers consider most important and can generate evidence on trajectories of change in those problems during treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/a0023307DOI Listing
June 2011

Assessing secondary control and its association with youth depression symptoms.

J Abnorm Child Psychol 2010 Oct;38(7):883-93

Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA.

Extensive research has linked youth depression symptoms to low levels of perceived control, using measures that reflect primary control (i.e., influencing objective conditions to make them fit one's wishes). We hypothesized that depressive symptoms are also linked to low levels of secondary control (i.e., influencing the psychological impact of objective conditions by adjusting oneself to fit them). To test the hypothesis, we developed the Secondary Control Scale for Children (SCSC), examined its psychometrics, and used it to assess the secondary control-depression symptomatology association. In a large adolescent sample, the SCSC showed factorial integrity, internal consistency, test-retest stability, convergent and discriminant validity, and accounted for more than 40% of the variance in depression symptoms. Consistent with evidence on risk and gender, depression symptoms were more strongly associated with secondary control in girls and primary control in boys. Assessing secondary control may help us understand youth depression vulnerability in girls and boys.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10802-010-9440-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001242PMC
October 2010

Testing a gender additive model: the role of body image in adolescent depression.

J Abnorm Child Psychol 2008 Nov;36(8):1251-63

Judge Baker Children's Center, Harvard Medical School, 53 Parker Hill Avenue, Boston, MA, USA.

Despite consistent evidence that adolescent girls are at greater risk of developing depression than adolescent boys, risk factor models that account for this difference have been elusive. The objective of this research was to examine risk factors proposed by the gender additive model of depression that attempts to partially explain the increased prevalence of depression in adolescent girls. The theory suggests that body image and eating related variables predict depression for girls, but not for boys, above and beyond the variance accounted for by other well-known risk factors, some of which were examined in the current study. The sample was 247 adolescent girls and 181 adolescent boys studied over a 24-month duration. Results suggest that body dissatisfaction is a potent predictor of depression for girls, but not for boys, above and beyond the predictive effects of other established risk factors. Results provide insight into the etiology of adolescent depression and the disparate rate of depression among adolescent girls and provide direction for identifying high-risk individuals and developing effective prevention programs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10802-008-9248-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3606557PMC
November 2008

Universal and targeted cognitive behavioural approaches do not reduce depression in young people at risk of depression.

Evid Based Ment Health 2006 Nov;9(4):96

Judge Baker Children's Center, Harvard University, Boston, Massachusetts, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/ebmh.9.4.96DOI Listing
November 2006