Skip to main content

Advertisement

SpringerLink
Log in

Evidence-Based Treatments in Community Mental Health Settings: Use and Congruence With Children’s Primary Diagnosis and Comorbidity

  • Published:
Research on Child and Adolescent Psychopathology Aims and scope Submit manuscript

Abstract

Many evidence-based treatments (EBTs) have been identified for specific child mental health disorders, but there is limited research on the use of EBTs in community-based settings. This study used administrative data from a statewide system of care to examine 1) the extent to which EBTs were provided congruent with the child’s primary diagnosis, 2) whether there were differences in effectiveness of EBTs that were congruent or incongruent with the child’s primary diagnosis, and 3) whether comorbidity moderated the effectiveness of EBTs for children based on congruence with their primary diagnosis. The sample consisted of 23,895 children ages 3–17 with at least one of the most common diagnoses (attention-deficit/hyperactivity disorder, conduct problems, depressive disorders, anxiety disorders, and post-traumatic stress disorder) who received outpatient psychotherapy. Data were collected as part of routine care, including child demographic characteristics, diagnosis, treatment type, and problem severity. Forty-two percent of children received an EBT congruent with their diagnosis, and these children showed greater improvement than the 35% of children who received no EBT (ES = 0.14–0.16) or the 23% who received an EBT incongruent with their diagnosis (ES = 0.06–0.15). For children with comorbid diagnoses, the use of EBTs congruent with the primary diagnosis was also associated with the greatest improvement, especially when compared to no EBT (ES = 0.22–0.24). Results of the current study support the use of EBTs in community-based settings, and suggest that clinicians should select EBTs that match the child’s primary diagnosis to optimize treatment outcomes, especially for children with comorbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. For simplicity, “comorbidity” is used in this paper to refer to children with more than one diagnosis.

References

  • Alisic, E., Zalta, A. K., Van Wesel, F., Larsen, S. E., Hafstad, G. S., Hassanpour, K., & Smid, G. E. (2014). Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: Meta-analysis. The British Journal of Psychiatry, 204(5), 335–340. https://doi.org/10.1192/bjp.bp.113.131227

    Article  PubMed  Google Scholar 

  • Baker-Ericzén, M. J., Hurlburt, M. S., Brookman-Frazee, L., Jenkins, M. M., & Hough, R. L. (2010). Comparing child, parent, and family characteristics in usual care and empirically supported treatment research samples for children with disruptive behavior disorders. Journal of Emotional and Behavioral Disorders, 18(2), 82–99. https://doi.org/10.1177/1063426609336956

    Article  Google Scholar 

  • Barkley, R. A. (2013). Defiant children: A clinician’s manual for assessment and parent training. The Guilford Press.

    Google Scholar 

  • Cary, C. E., & McMillen, J. C. (2012). The data behind the dissemination: A systematic review of trauma-focused cognitive behavioral therapy for use with children and youth. Children and Youth Services Review, 34(4), 748–757. https://doi.org/10.1016/j.childyouth.2012.01.003

    Article  Google Scholar 

  • Chorpita, B. F., Daleiden, E. L., & Weisz, J. R. (2005). Identifying and selecting the common elements of evidence based interventions: A distillation and matching model. Mental Health Services Research, 7(1), 5–20. https://doi.org/10.1007/s11020-005-1962-6

    Article  PubMed  Google Scholar 

  • Chorpita, B. F., Daleiden, E. L., Ebesutani, C., Young, J., Becker, K. D., Nakamura, B. J., Phillips, L., Ward, A., Lynch, R., Trent, L., Smith, R. L., Okamura, K., & Starace, N. (2011). Evidence-based treatments for children and adolescents: An updated review of indicators of efficacy and effectiveness. Clinical Psychology: Science and Practice, 18(2), 154–172. https://doi.org/10.1111/j.1468-2850.2011.01247.x

    Article  Google Scholar 

  • Chorpita, B. F., Daleiden, E. L., Park, A. L., Ward, A. M., Levy, M. C., Cromley, T., Chiu, A. W., Letamendi, A. M., Tsai, K. H., & Krull, J. L. (2017). Child STEPs in California: A cluster randomized effectiveness trial comparing modular treatment with community implemented treatment for youth with anxiety, depression, conduct problems, or traumatic stress. Journal of Consulting and Clinical Psychology, 85(1), 13–25. https://doi.org/10.1037/ccp0000133

    Article  PubMed  Google Scholar 

  • Chorpita, B. F., Weisz, J. R., Daleiden, E. L., Schoenwald, S. K., Palinkas, L. A., Miranda, J., Higa-McMillan, C. K., Nakamura, B. J., Austin, A. A., Borntrager, C. F., Ward, A., Wells, K. C., Gibbons, R., & Research Network on Youth Mental Health. (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(6), 999–1099. https://doi.org/10.1037/a0034200

    Article  Google Scholar 

  • Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents. The Guilford Press.

    Google Scholar 

  • Conners, C. K. (2002). Forty years of methylphenidate treatment in attention-deficit/ hyperactivity disorder. Journal of Attention Disorders, 6(Suppl. 1), S17–S30. https://doi.org/10.1177/070674370200601S04

    Article  PubMed  Google Scholar 

  • Deighton, J., Argent, R., De Francesco, D., Edbrooke-Childs, J., Jacob, J., Fleming, I., Ford, T., & Wolpert, M. (2016). Associations between evidence-based practice and mental health outcomes in child and adolescent mental health services. Clinical Child Psychology and Psychiatry, 21(2), 287–296. https://doi.org/10.1177/1359104515589637

    Article  PubMed  Google Scholar 

  • Dorsey, S., McLaughlin, K. A., Kerns, S. E., Harrison, J. P., Lambert, H. K., Briggs, E. C., Cox, J. R., & Amaya-Jackson, L. (2017). Evidence base update for psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child & Adolescent Psychology, 46(3), 303–330. https://doi.org/10.1080/15374416.2016.1220309

    Article  Google Scholar 

  • Durlak, J. A. (2009). How to select, calculate, and interpret effect sizes. Journal of Pediatric Psychology, 34(9), 917–928. https://doi.org/10.1093/jpepsy/jsp004

    Article  PubMed  Google Scholar 

  • Evans, S. W., Owens, J. S., & Bunford, N. (2014). Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 43(4), 527–551. https://doi.org/10.1080/15374416.2013.850700

    Article  Google Scholar 

  • Evans, S. W., Owens, J. S., & Power, T. J. (2019). Attention-deficit/hyperactivity disorder. In M. J. Prinstein, E. A. Youngstrom, E. J. Mash, & R. A. Barkley (Eds.), Treatment of disorders in childhood and adolescence (pp. 47–101). The Guilford Press.

    Google Scholar 

  • Finkelhor, D., Turner, H. A., Shattuck, A., & Hamby, S. L. (2015). Prevalence of childhood exposure to violence, crime, and abuse: Results from the national survey of children’s exposure to violence. JAMA Pediatrics, 169(8), 746–754. https://doi.org/10.1001/jamapediatrics.2015.0676

    Article  PubMed  Google Scholar 

  • Garland, A. F., Accurso, E. C., Haine-Schlagel, R., Brookman-Frazee, L., Roesch, S., & Zhang, J. J. (2014). Searching for elements of evidence-based practices in children’s usual care and examining their impact. Journal of Clinical Child & Adolescent Psychology, 43(2), 201–215. https://doi.org/10.1080/15374416.2013.869750

    Article  Google Scholar 

  • Garland, A. F., Brookman-Frazee, L., Hurlburt, M. S., Accurso, E. C., Zoffness, R. J., Haine-Schlagel, R., & Ganger, W. (2010). Mental health care for children with disruptive behavior problems: A view inside therapists’ offices. Psychiatric Services, 61(8), 788–795. https://doi.org/10.1176/ps.2010.61.8.788

    Article  PubMed  Google Scholar 

  • Garland, A. F., Hough, R. L., McCabe, K. M., Yeh, M. A. Y., Wood, P. A., & Aarons, G. A. (2001). Prevalence of psychiatric disorders in youths across five sectors of care. Journal of the American Academy of Child & Adolescent Psychiatry, 40(4), 409–418. https://doi.org/10.1097/00004583-200104000-00009

    Article  Google Scholar 

  • Ghandour, R. M., Sherman, L. J., Vladutiu, C. J., Ali, M. M., Lynch, S. E., Bitsko, R. H., & Blumberg, S. J. (2019). Prevalence and treatment of depression, anxiety, and conduct problems in US children. The Journal of Pediatrics, 206, 256–267. https://doi.org/10.1016/j.jpeds.2018.09.021

    Article  PubMed  Google Scholar 

  • Higa-McMillan, C. K., Francis, S. E., Rith-Najarian, L., & Chorpita, B. F. (2016). Evidence base update: 50 years of research on treatment for child and adolescent anxiety. Journal of Clinical Child & Adolescent Psychology, 45(2), 91–113. https://doi.org/10.1080/15374416.2015.1046177

    Article  Google Scholar 

  • Hunsley, J. (2007). Addressing key challenges in evidence-based practice in psychology. Professional Psychology: Research and Practice, 38(2), 113–121. https://doi.org/10.1037/0735-7028.38.2.113

    Article  Google Scholar 

  • Kaminski, J. W., & Claussen, A. H. (2017). Evidence base update for psychosocial treatments for disruptive behaviors in children. Journal of Clinical Child & Adolescent Psychology, 46(4), 477–499. https://doi.org/10.1080/15374416.2017.1310044

    Article  Google Scholar 

  • Kendall, P. C., & Hedtke, K. A. (2006). Cognitive-behavioral therapy for anxious children: Therapist manual (3rd ed.). Workbook Publishing.

  • Lang, J. M., Franks, R. P., Epstein, C., Stover, C., & Oliver, J. A. (2015). Statewide dissemination of an evidence-based practice using Breakthrough Series Collaboratives. Children and Youth Services Review, 55, 201–209. https://doi.org/10.1016/j.childyouth.2015.06.005

    Article  Google Scholar 

  • Lang, J. M., Lee, P., Connell, C. M., Marshall, T., & Vanderploeg, J. J. (2021). Outcomes, evidence-based treatments, and disparities in a statewide outpatient children’s behavioral health system. Children and Youth Services Review, 120, Article 105729. https://doi.org/10.1016/j.childyouth.2020.105729

  • Lang, J. M., Randall, K., Delaney, M., & Vanderploeg, J. J. (2017). A Model for Sustaining Evidence-Based Practices in a Statewide System. Families in Society, 98(1), 18–26. https://doi.org/10.1606/1044-3894.2017.5

  • McCart, M. R., & Sheidow, A. J. (2016). Evidence-based psychosocial treatments for adolescents with disruptive behavior. Journal of Clinical Child & Adolescent Psychology, 45(5), 529–563. https://doi.org/10.1080/15374416.2016.1146990

    Article  Google Scholar 

  • Milette-Winfree, M., & Mueller, C. W. (2018). Treatment-as-usual therapy targets for comorbid youth disproportionately focus on externalizing problems. Psychological Services, 15(1), 65–77. https://doi.org/10.1037/ser0000162

    Article  PubMed  Google Scholar 

  • Miller, M., & Hinshaw, S. P. (2012). Attention-deficit/hyperactivity disorder. In P. C. Kendall (Ed.), Child and adolescent therapy: Cognitive-behavioral procedures (pp. 61–91). The Guilford Press.

    Google Scholar 

  • Mueller, C. W., Tolman, R., Higa-McMillan, C. K., & Daleiden, E. L. (2010). Longitudinal predictors of youth functional improvement in a public mental health system. The Journal of Behavioral Health Services & Research, 37(3), 350–362. https://doi.org/10.1007/s11414-009-9172-4

    Article  Google Scholar 

  • Ogles, B. M., Melendez, G., Davis, D. C., & Lunnen, K. M. (1999). The Ohio Youth Problems, Functioning, and Satisfaction Scales (Short Form): User's Manual. Columbus, OH: Ohio Department of Mental Health, Office of Program Evaluation and Research.

  • Ogles, B. M., Melendez, G., Davis, D. C., & Lunnen, K. M. (2000). The Ohio Youth Problem, Functioning, and Satisfaciton Scales: Technical Manual. Columbus, OH: Ohio Department of Mental Health.

  • Park, A. L., Moskowitz, A. L., & Chorpita, B. F. (2018). Community-based providers’ selection of practices for children and adolescents with comorbid mental health problems. Journal of Clinical Child & Adolescent Psychology, 47(5), 796–807. https://doi.org/10.1080/15374416.2016.1188706

    Article  Google Scholar 

  • Prinstein, M. J., Youngstrom, E. A., Mash, E. J., & Barkley, R. A. (Eds.). (2019). Treatment of disorders in childhood and adolescence. The Guilford Press.

  • Southam-Gerow, M. A., & Prinstein, M. J. (2014). Evidence base updates: The evolution of the evaluation of psychological treatments for children and adolescents. Journal of Clinical Child & Adolescent Psychology, 43(1), 1–6. https://doi.org/10.1080/15374416.2013.855128

    Article  Google Scholar 

  • Stewart, R. E., Stirman, S. W., & Chambless, D. L. (2012). A qualitative investigation of practicing psychologists’ attitudes toward research-informed practice: Implications for dissemination strategies. Professional Psychology: Research and Practice, 43(2), 100–109. https://doi.org/10.1037/a0025694

    Article  Google Scholar 

  • Tam, K. K. (2006). Reliable change and clinical significance for outcomes instruments. Columbus, OH: Ohio Department of Mental Health, Office of Program Evaluation and Research. http://mha.ohio.gov/Portals/0/assets/Planning/OutcomesResearch/reports/quarterly-12.pdf

  • Tam, K. K., & Healy, J. (2006). Benchmarks for reliable change and clinical significance on the Ohio Scales for Youth - Problem and Functioning Scales. Columbus, OH: Ohio Department of Mental Health, Office of Program Evaluation and Research. http://mha.ohio.gov/Portals/0/assets/Planning/OutcomesResearch/reports/quarterly-16.pdf

  • Vidal, S., & Connell, C. M. (2019). Treatment Effects of Parent-Child Focused Evidence-Based Programs on Problem Severity and Functioning among Children and Adolescents with Disruptive Behavior. Journal of Clinical Child & Adolescent Psychology, 48(sup1), S326–S336. https://doi.org/10.1080/15374416.2018.1469092

    Article  Google Scholar 

  • Warren, J. S., Nelson, P. L., Mondragon, S. A., Baldwin, S. A., & Burlingame, G. M. (2010). Youth psychotherapy change trajectories and outcomes in usual care: Community mental health versus managed care settings. Journal of Consulting and Clinical Psychology, 78(2), 144–155. https://doi.org/10.1037/a0018544

    Article  PubMed  Google Scholar 

  • Weersing, V. R., Jeffreys, M., Do, M. C. T., Schwartz, K. T., & Bolano, C. (2017). Evidence base update of psychosocial treatments for child and adolescent depression. Journal of Clinical Child & Adolescent Psychology, 46(1), 11–43. https://doi.org/10.1080/15374416.2016.1220310

    Article  Google Scholar 

  • Weisz, J. R., Chorpita, B. F., Palinkas, L. A., Schoenwald, S. K., Miranda, J., Bearman, S. K., Daleiden, E. L., Ugueto, A. M., Ho, A., Martin, J., Gray, J., Alleyne, A., Langer, D. A., Southam-Gerow, M. A., Gibbons, R. D., & the Research Network on Youth Mental Health. (2012). Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: A randomized effectiveness trial. Archives of General Psychiatry, 69(3), 274–282. https://doi.org/10.1001/archgenpsychiatry.2011.147

    Article  Google Scholar 

  • Weisz, J. R., Doss, A. J., & Hawley, K. M. (2005). Youth psychotherapy outcome research: A review and critique of the evidence base. Annual Review of Psychology, 56, 337–363. https://doi.org/10.1146/annurev.psych.55.090902.141449

    Article  PubMed  Google Scholar 

  • Weisz, J. R., Kuppens, S., Eckshtain, D., Ugueto, A. M., Hawley, K. M., & Jensen-Doss, A. (2013a). Performance of evidence-based youth psychotherapies compared with usual clinical care: A multilevel meta-analysis. JAMA Psychiatry, 70(7), 750–761. https://doi.org/10.1001/jamapsychiatry.2013.1176

    Article  PubMed  Google Scholar 

  • Weisz, J. R., Kuppens, S., Ng, M. Y., Eckshtain, D., Ugueto, A. M., Vaughn-Coaxum, R., Jensen-Doss, A., Hawley, K. M., Krumholz Marchette, L. S., Chu, B. C., Weersing, V. R., & Fordwood, S. R. (2017). What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice. American Psychologist, 72(2), 79–117. https://doi.org/10.1037/a0040360

    Article  Google Scholar 

  • Weisz, J. R., Southam-Gerow, M. A., Gordis, E. B., Connor-Smith, J. K., Chu, B. C., Langer, D. A., McLeod, B. D., Jensen-Doss, A., Updegraff, A., & Weiss, B. (2009). Cognitive–behavioral therapy versus usual clinical care for youth depression: An initial test of transportability to community clinics and clinicians. Journal of Consulting and Clinical Psychology, 77(3), 383–396. https://doi.org/10.1037/a0013877

    Article  PubMed  PubMed Central  Google Scholar 

  • Weisz, J. R., Ugueto, A. M., Cheron, D. M., & Herren, J. (2013b). Evidence-based youth psychotherapy in the mental health ecosystem. Journal of Clinical Child & Adolescent Psychology, 42(2), 274–286. https://doi.org/10.1080/15374416.2013.764824

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge and thank Yvette Cortez, Jack Lu, Kellie Randall, Bethany Zorba, and all of the Connecticut outpatient providers.

Funding

This was an unfunded study.

Author information

Authors and Affiliations

  1. Department of Psychological Science, Eastern Connecticut State University, Willimantic, CT, USA

    Phyllis Lee

  2. Child Health and Development Institute, Farmington, CT, USA

    Jason M. Lang & Jeffrey J. Vanderploeg

  3. Connecticut Department of Children and Families, Hartford, CT, USA

    Timothy Marshall

  4. Department of Psychiatry, UCONN Health, Farmington, CT, USA

    Jason M. Lang & Jeffrey J. Vanderploeg

  5. Child Study Center, Yale Schools of Medicine, New Haven, CT, USA

    Jason M. Lang

  6. The Consultation Center, Yale Schools of Medicine, New Haven, CT, USA

    Jeffrey J. Vanderploeg

Authors
  1. Phyllis Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jason M. Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeffrey J. Vanderploeg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Timothy Marshall
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Phyllis Lee.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

This study used de-identified archived administrative data that was determined not to qualify as human subjects research by the Eastern Connecticut State University IRB.

Informed Consent

Consent/assent for treatment was originally obtained by each provider as part of their routine intake and treatment process.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, P., Lang, J.M., Vanderploeg, J.J. et al. Evidence-Based Treatments in Community Mental Health Settings: Use and Congruence With Children’s Primary Diagnosis and Comorbidity. Res Child Adolesc Psychopathol 50, 417–430 (2022). https://doi.org/10.1007/s10802-021-00877-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-021-00877-y

Keywords

Search

Navigation