Our understanding of child, adolescent, and caregiver mental health (MH) problems during the coronavirus pandemic, and which interventions are needed, may be advanced by consumer input. 133 general population caregivers reported top MH problems and needs for themselves and their children ( M age = 8.21; SD = 4.94), using standardized and idiographic measures. We applied linear regression models to quantitative data and thematic analysis to qualitative data. Caregivers’ COVID-era depression and anxiety symptom means fell within the clinical range, as did their children’s MH symptoms. Caregiver-reported child and adolescent symptoms were positively associated with number of children in the home. Caregiver and caregiver-reported child and adolescent symptoms were more pronounced in regions with more lenient COVID-19 restrictions. Among the kinds of help most urgently needed, MH services were ranked #1 for caregivers and adolescents, #2 for 6–12 year-olds, and #3 for 1–5 year-olds. Top problems identified for each age group highlight pressing pandemic-related intervention targets. Electronic supplementary material The online version of this article (10.1007/s10578-020-01089-z) contains supplementary material, which is available to authorized users.

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Objective: Research suggests that decreases in negative cognitions coincide with symptom improvements over the course of cognitive therapy (CT) of depression, but the role cognitive change (CC) plays in reducing symptoms remains controversial. Method: A total of 126 adults (mean age = 31.7, SD = 13.35; 60% female; 83% Caucasian) participated in CT for depression. Patients completed the Beck Depression Inventory–II and the Immediate Cognitive Change Scale at each session. At intake evaluation, maladaptive personality traits (Personality Inventory for DSM–5, Brief Form) and interpersonal problems (Inventory of Interpersonal Problems, Short Version) were assessed via self-report, and social skills were assessed through patients’ evaluation of their performance following a series of behavioral role-plays (standardized interaction task). To rule out between-patient differences as potential confounds, our model disaggregated within- and between-patient components of CC and depression scores. Results: Within-patient CC significantly predicted within-patient change in depressive symptoms. This relation was moderated by patients’ evaluations of their social skills and patients’ level of interpersonal problems, with CC predicting symptoms more robustly for patients with fewer perceived social skills and for those with greater interpersonal problems. Maladaptive personality traits did not emerge as a moderator. Additional analyses showed the relation of CC and symptom change was particularly strong among those with social anxiety disorder and among those observers rated as having lower social skills. Conclusions: CC in CT sessions appears to foster subsequent depressive symptom reduction, especially among patients with lower levels of self-evaluated social skills and greater interpersonal problems.

Objective Suicide is a leading cause of adolescent death. Recent data support the efficacy of cognitive–behavioral treatments with strong family components for reducing suicide risk; however, not all youth benefit from current interventions. Identifying predictors of treatment response can inform treatment selection and optimize benefits. Method This study examines predictors of response to a DBT‐informed cognitive–behavioral family treatment (SAFETY), among 50 youth with recent suicide attempts/self‐harm. Youth and parents were assessed at baseline and post‐treatment. Results Results indicated medium‐to‐large effect sizes for SAFETY on youth suicidal behavior (SB; defined as suicide attempts, aborted attempts, and planning), depression, hopelessness, social adjustment, and parental depression. Classification tree analysis, with a correct classification rate of 93.3%, and follow‐up logistic analyses indicated that 35% of youths reporting active SB at baseline reported active SB at post‐treatment, whereas post‐treatment SB was rare among youths whose active suicidality had resolved by the baseline assessment (5%). Among youths reporting baseline SB, those endorsing sleep problems were more likely to report post‐treatment SB (53%) versus those without sleep problems (0%). Conclusions These findings highlight the potential value of personalized treatment approaches based on pretreatment characteristics and the significance of baseline SB and sleep problems for predicting treatment response.

Reports on remote psychotherapies for youth (e.g., technology-based treatment) suggest it is acceptable, feasible, and useful in overcoming logistical barriers to treatment. But how effective is remote care? To find out, PsycINFO and PubMed were searched from 1960 through 2020, supplemented by journal searches and reference trails, to identify randomized controlled trials of youth psychotherapy for anxiety (including obsessive–compulsive disorder and trauma), depression, attention-deficit/hyperactivity disorder (ADHD), or conduct problems, in which all therapeutic contact occurred remotely. Articles (N = 37) published from 1988 through 2020, reporting 43 treatment-control group comparisons, were identified. Robust variance estimation was used to account for effect size dependencies and to synthesize overall effects and test candidate moderators. Pooled effect size was .47 (95% confidence interval [CI: .26, .67], p < .001) at posttreatment, .44 (95% CI [.12, .76], p < .05) at follow-up—comparable to effects reported in meta-analyses of in-person youth psychotherapy. Effects were significantly (a) larger for remote psychotherapies supported by therapeutic provider contact (.64) than for those accessed by youths, with only logistical support (.22), (b) larger for treatments with phone contact (.65) than for those without (.25), (c) larger for treatment of anxiety (.62) and conduct problems (.78) than ADHD (–.03), and (d) smaller for therapies involving attention/working memory training (–.18) than for those without (.60). Among studies with therapeutic contact, effects were significantly larger when therapists facilitated skill-building (e.g., practicing exposures or problem solving [.68]) than when therapists did not (.18). These findings support the effectiveness of remote psychotherapies for youths, and they highlight moderators of treatment benefit that warrant attention in future research.

UC+ and the behavioral health intervention yielded similar benefits in reducing HRBs and depressive symptoms. Findings underscore the bidirectional links between depression and HRBs, supporting the importance of monitoring for HRBs and depression in PC to allow for effective intervention in both areas.

Modular youth psychotherapies are increasingly popular, in part because their flexibility facilitates personalizing, but the clinician decision-making required can be complex. We investigated decision guidance in 20 modular youth psychotherapies, described in 67 articles identified via a systematic search. Decision guidance was limited. Clinical judgment was recommended in all therapies; 95% recommended using baseline assessment, 65% measurement-based care, and 25% prior research. Most commonly, guidance involved module descriptions (90%); some therapies provided decision flow diagrams (35%); one provided an online decision tool. Only 40% proposed seeking client input. Despite evidence that statistical models outperform clinical judgment, no modular psychotherapy used statistical models. Maximizing therapy effectiveness may require building decision supports that incorporate client perspectives and balance clinical judgment with statistical methods. Public Health Significance StatementModular youth psychotherapies may offer advantages for clinical practice because of their potential to be personalized to fit individual youths; however, the clinician decision-making required for such personalizing can be complex. In this scoping review, we gathered relevant protocols of modular psychotherapies published to date, finding that decision-making in modular psychotherapies often relies on clinical judgments, and rarely involves input from clients, statistical models, or algorithms. Future research focused on associations between decision-making procedures and clinical outcomes may improve the implementation and effectiveness of modular youth psychotherapies in clinical practice.

Intervention scientists have proposed a focus on empirically supported principles of change (ESPCs) in psychotherapies. We explored this proposition as applied to youth psychotherapies, focusing on five candidate ESPCs—calming, increasing motivation, changing unhelpful thoughts, solving problems, and practicing positive opposites. We synthesized 348 treatment–control comparisons from 263 randomized controlled trials (RCTs) spanning six decades, testing treatments for anxiety, depression, attention-deficit/hyperactivity disorder, and conduct problems. We found that ESPCs could be reliably identified and distinguished by independent coders and that psychotherapies most often included fewer than three ESPCs. However, across the entire study pool and the anxiety subsample, when we controlled for dose, treatments with all five ESPCs showed effects about twice as large as treatments with fewer ESPCs. The findings suggest that ESPCs are reliably identifiable, that they are associated with variations in treatment effect size, and that treatments containing more ESPCs may produce greater therapeutic benefit.