Original Paper

Administration and Policy in Mental Health and Mental Health Services Research

, Volume 37, Issue 1, pp 15-26

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Change What? Identifying Quality Improvement Targets by Investigating Usual Mental Health Care

  • Ann F. GarlandAffiliated withUniversity of California, San Diego Email author 
  • , Leonard BickmanAffiliated withVanderbilt University
  • , Bruce F. ChorpitaAffiliated withUniversity of California


Efforts to improve community-based children’s mental health care should be based on valid information about effective practices and current routine practices. Emerging research on routine care practices and outcomes has identified discrepancies between evidence-based practices and “usual care.” These discrepancies highlight potentially potent quality improvement interventions. This article reviews existing research on routine or “usual care” practice, identifies strengths and weaknesses in routine psychotherapeutic care, as well as gaps in knowledge, and proposes quality improvement recommendations based on existing data to improve the effectiveness of children’s mental health care. The two broad recommendations for bridging the research-practice gap are to implement valid, feasible measurement feedback systems and clinician training in common elements of evidence-based practice.


Usual care Psychotherapy