Samenvatting
Bij het bepalen van de effectiviteit van zorg heeft de nadruk zeer sterk gelegen op de zogenaamde ‘evidence based practice’ (EBP), waarbij het vaak ging over ‘bewezen effectieve behandelingen’. Wat echter steeds bleek: de behandelingen verschillen van elkaar, maar ze lijken heel sterk op elkaar wat betreft hun resultaten. Om het vraagstuk van het verbeteren van de effectiviteit op te lossen, zullen niet alleen de specifiek werkzame elementen of technieken van de interventies in kaart moeten worden gebracht, maar ook de algemeen werkzame factoren. Eén daarvan wordt in de literatuur vooral veel als belangrijke factor genoemd: de alliantie (de werkrelatie tussen therapeut en cliënt). Het voorgaande betekent dat we de interventies en EBP minder als uitgangspunten moeten nemen voor effectiviteit van de zorg, maar veel meer nadruk moeten leggen op de individuele cliënt en gepersonaliseerde zorg. Een cruciale rol is daarin weggelegd voor het voor en tijdens de behandeling meten van de afname van de problemen en de kwaliteit van de alliantie, en voor het benutten van deze data. Dit kan via feedbacksystemen (Feedback Informed Treatment, FIT). Uiteindelijk heeft de gepersonaliseerde zorg de potentie om de jeugdzorg te optimaliseren.
Abstract
The past two decades have witnessed an increased emphasis on evidence-based treatments as the best way of providing effective care. More recently, in view of the finding that differences between treatments only have a marginal effect on treatment outcomes, techniques or common elements have been assumed to be more predictive for outcomes. At the same time it has been established that common factors, especially the therapeutic alliance, predict treatment outcomes. All of these findings suggest that if we want to improve youth care, we should opt for practice-based evidence instead of evidence-based practice. More specifically, youth care can benefit from Feedback Informed Treatment (FIT), a data-based approach in which different types of data on each individual client are gathered and used in treatment. As such, FIT will enhance personalized treatment, i.e. treatment that focuses on individual clients, applying information about the individual client (e.g. diagnoses and demands), the treatment (e. g. alliance and common elements), and the context (e. g. the quality of the care offered). Ultimately, personalized treatment has the potential to optimize youth care.
Literatuur
Atzil-Slonim, D., Bar-Kalifa, E., Rafaeli, E., Lutz, W., Rubel, J., Schiefele, A. K., & Peri, T. (2015). Therapeutic bond judgments: congruence and incongruence. Journal of Consulting and Clinical Psychology, 83, 773–784.
Barnhoorn, J., Broeren, S., Distelbrink, M., De Greef, M., Van Grieken, A., Jansen, W., Pels, T., Pijnenburg, H., & Raat, H. (2013). Cliënt-, professional- en alliantiefactoren: hun relatie met het effect van zorg voor jeugd. Verkenning van kennis en kennishiaten voor het ZonMw-programma Effectief werken in de jeugdsector. Den Haag: ZonMw.
Barth, R. P., Lee, B. R., Lindsey, M. A., Collins, K. S., Strieder, F., Chorpita, B. F., Bekcer, K. D., & Sparks, J. A. (2012). Evidence-based practice at a crossroad: the timely emergence of common elements and common factors. Research on Social Work Practice, 22, 108–119.
Bickman, L., Andrade, A. R. V. de, Athay, M. M., Chen, J. I., De Nadai, A. S., Jordan-Athur, B. L., & Karver, M. S. (2012). The relationship between change in therapeutic alliance ratings and improvement in youth symptom severity: Whose ratings matter the most? Administration and Policy in Mental Health, 39, 78–89.
Bickman, L., Lyon, A. R., & Wolpert, M. (2016). Achieving precision mental health through effective assessment, monitoring, and feedback processes. Administration and Policy in Mental Health, 43, 271–276.
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research, and Practice, 16, 252–260.
CBS (2016). https://www.cbs.nl/nl-nl/nieuws/2016/17/een-op-de-tien-jongeren-krijgt-jeugdhulp. Geraadpleegd op: 16 december 2016.
Chorpita, B. F., & Daleiden, E. L. (2009). Mapping evidence-based treatments for children and adolescents: application of the distillation and matching model to 615 treatments from 322 randomized trials. Journal of Consulting and Clinical Psychology, 77, 566–579.
Chorpita, B. F., Daleiden, E., & Weisz, J. R. (2005). Identifying and selecting the common elements of evidence based interventions: a distillation and matching model. Mental Health Services Research, 7, 5–20.
Chorpita, B. F., Weisz, J. R., Daleiden, E. L., Schoenwald, S. K., Palinkas, L. A., et al. (2013). Long-term outcomes for the Child STEPs randomized effectiveness trial: a comparison of modular and standard treatment designs with usual care. Journal of Consulting and Clinical Psychology, 81, 999–1009.
Duncan, B. L., Miller, S. D., Wampold, B. E., & Hubble, M. A. (2010). The heart and soul of change: delivering what works in therapy (2e druk.). Washington, DC: American Psychological Association.
Elvins, R., & Green, J. (2008). The conceptualization and measurement of therapeutic alliance: an empirical review. Clinical Psychology Review, 28, 1167–1187.
Embry, D. D., & Biglan, A. (2008). Evidence-based kernels: fundamental units of behavioral influence. Clinical Child and Family Psychology Review, 11, 75–113.
Hannan, C., Lambert, M., Harmon, C., Nielsen, L. S., Smart, D. W., & Shimokawa, K. (2005). A lab test and algorithms for identifying clients at risk for failure. Journal of Clinical Psychology, 61, 155–163.
Helm, G. H. P. van der, Genabeek, M. van, Stams, G. J. J. M., & Laan, P. H. van der (2011). Violence in youth prison: the role of group climate and personality. Journal of Forensic Psychiatry & Psychology, 1, 23–40.
Hitchcock, J. H., Kratichwull, T. R., & Chezan, L. C. (2015). What works clearinghouse standards and generalization of single-case design evidence. Journal of Behavioral Education, 24, 459–469.
Horvath, A., Del Re, A. C., Fluckiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48, 9–16.
Karver, M. S., Handelsman, J. B., Fields, S., & Bickman, L. (2006). Meta-analysis of therapeutic relationship variables in youth and family therapy: the evidence for different relationship variables in the child and adolescent treatment outcome literature. Clinical Psychology Review, 26, 50–65.
Kazdin, A. E. (2004). Psychotherapy for children and adolescents. In M. J. Lambert (red.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5e druk. pag. 543–589). New York: Wiley.
Kazdin, A. E. (2007). Child psychotherapy research: issues and opportunities. In L. Mayes, P. Fonagy & M. Target (red.), Developmental science and psychoanalysis: integration and innovation (pag. 193–223). London: Karnac Books.
Kelley, S. D., Bickman, L., & Norwood, E. (2010). Evidence-based treatments and common factors in youth psychotherapy. In B. L. Duncan, S. D. Miller, B. E. Wampold & M. A. Hubble (red.), The heart and soul of change: delivering what works in therapy (2e druk. pag. 325–355). Washington DC: American Psychological Association.
Korelitz, K. E., & Garber, J. (2016). Congruence of parents’ and children’s perceptions of parenting: a meta-analysis. Journal of Youth and Adolescence, 45, 1973–1995.
Lamers, A. (2016). Towards a strong parent-team alliance for improved treatment outcomes in child residential psychiatry. dissertatie, Universiteit Leiden.
Laska, K. M., Gurman, A. S., & Wampold, B. E. (2014). Expanding the lens of evidence-based practice in psychotherapy: a common factors perspective. Psychotherapy, 51, 467–481.
Lee, B. R., Ebesutani, C., Kolikovski, K. M., Bekcer, K. D., Lindsey, M. A., et al. (2014). Program and practice elements for placement prevention: a review of interventions and their effectiveness in promoting home-based care. American Journal of Orthopsychiatry, 84, 244–256.
Lo Coco, G., Gullo, S., & Kivlighan Jr., D. M. (2012). Examining patients’ and other group members’ agreement about their alliance to the group as a whole and changes in patient symptoms using response surface analysis. Journal of Counseling Psychology, 59, 197–207.
May, A., & Mathijssen, J. (2015). Alternatieven voor RCT bij de evaluatie van effectiviteit van interventies!? Den Haag, Utrecht, Tilburg: ZonMw, UMC Utrecht, Tranzo.
Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., et al. (2013). The Behavior Change Technique Taxonomy (v1) of 93 hierarchically clustered techniques. Building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46, 81–95.
Miller, S. D., Hubble, M. A., Chow, D., & Seidel, J. (2015). Beyond measures and monitoring: realizing the potential of feedback-informed treatment. Psychotherapy, 52, 449–457.
Muñiz Peña, C. de la, Friedlander, M., & Escudero, V. (2009). Frequency, severity, and evolution of split family alliances: How observable are they? Psychotherapy Research, 19, 133–142.
Nederlandse Federatie van Universitair Medische Centra (2016). http://www.nfu.nl/programma/doen-of-laten-terugdringen-van-onnodige-zorg/status/. Geraadpleegd op: 16 december 2016.
Ng, M. Y., & Weisz, J. R. (2016). Annual research review: building a science of personalized intervention for youth mental health. Journal of Child Psychology and Psychiatry, 57, 216–236.
Nissen-Lie, H. A., Havik, O. E., Høglend, P. A., Rønnestad, M. H., & Monsen, J. T. (2015). Patient and therapist perspectives on alliance development: therapists’ practice experiences as predictors. Clinical Psychology and Psychotherapy, 22, 317–327.
Os, J. van, Kahn, R., Denys, D., Schoevers, R. A., Beekman, A. T. F., et al. (2012). ROM: gedragsnorm of dwangmaatregel? Tijdschrift voor Psychiatrie, 54, 245–253.
Robbins, M. S., Mayorga, C. C., Mitrani, V. B., Szapocznik, J., Turner, C. W., & Alexander, J. F. (2008). Adolescent and parent alliances with therapists in brief strategic family therapy with drug-using Hispanic adolescents. Journal of Marital and Family Therapy, 34, 316–328.
Sapyta, J., Riemer, M., & Bickman, L. (2005). Feedback to clinicians: theory, research, and practice. Journal of Clinical Psychology, 61, 145–153.
Scott, J., & Young, A. H. (2016). Psychotherapies should be assessed for both benefit and harm. British Journal of Psychiatry, 208, 208–209.
Spanjaard, H. J., Veerman, J. W., & Yperen, T. A. van (2015). De kern van effectieve jeugdhulp. Van erkende interventies naar werkzame elementen. Orthopedagogiek: Onderzoek en Praktijk, 54, 441–455.
Trimbos Instituut (2015). Implementatie van ROM ter ondersteuning van de dagelijkse zorgpraktijk in de GGZ
Tryon, G. S., Blackwell, S. C., & Hammel, E. F. (2007). A meta-analytic examination of client-therapist perspectives of the working alliance. Psychotherapy Research, 17, 629–642.
de Volkskrant 22-2-2014. Specialisten komen met lijst onzinbehandelingen.
de Volkskrant 7-8-2016. Britse tandartsen trekken nodeloos duizenden tanden en kiezen.
Wampold, B. E., Mondin, G. W., Moody, M., Stich, F., Benson, K., & Ahn, H. (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: empirically, “all must have prices”. Psychological Bulletin, 122, 203–215.
Warren, J. S., Nelson, P. L., & Burlingame, G. M. (2009). Identifying youth at risk for treatment failure in outpatient community mental health services. Journal of Child and Family Studies, 18, 690–701.
Warren, J. S., Nelson, P. L., Mondragon, S. A., Baldwin, S. A., & Burlingame, G. M. (2010). Youth psychotherapy change trajectories and outcome in usual care: community mental health versus managed care settings. Journal of Consulting and Clinical Psychology, 78, 144–155.
Weisz, J. R., Jensen-Doss, A., & Hawley, K. M. (2006). Evidence-based youth psychotherapies versus usual clinical care: a meta-analysis of direct comparisons. American Psychologist, 61, 671–689.
Weisz, J. R., Kuppens, S., Eckshtain, D., Ugueto, A. M., Hawley, K. M., & Jensen-Doss, A. (2013). Performance of evidence-based youth psychotherapies compared with usual clinical care: a multilevel meta-analysis. JAMA Psychiatry, 70, 750–761.
Wienke, D., Anthonijsz, I., Abrahamse, S., Daamen, W., & Nieuwboer, A. (2014). Beoordeling anti-pestprogramma’s: Rapportage van de commissie voor het Ministerie Onderwijs, Cultuur en Wetenschap (OCW). Utrecht: NJi.
Wampold, B. E. (2009). Clinical trials and positivism: restricted evidence can be misleading. Canadian Journal of Psychiatry, 54, 642–643.
Author information
Authors and Affiliations
Corresponding author
Additional information
Dit artikel is een bewerking van de inaugurele rede van prof. dr. Ron Scholte, uitgesproken aan de Radboud Universiteit op 16 december 2016.
About this article
Cite this article
Scholte, R. Effectiviteit van de jeugdzorg: passen en meten. Kind Adolesc 38, 91–107 (2017). https://doi.org/10.1007/s12453-017-0141-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12453-017-0141-z