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.

Chorpita, Bruce F.; Daleiden, Eric L.; Park, Alayna L.; Ward, Alyssa; Levy, Michelle C.; Cromley, Taya; Chiu, Angela W.; Letamendi, Andrea; Tsai, Katherine; Krull, Jennifer L.

doi:10.1037/ccp0000133

Cited by 169 publications

(148 citation statements)

References 60 publications

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“…Of interest, all of these practices were the first skills that providers would have taught to clients, following any engagement and psychoeducation practices, if they were adhering to the default sequences of practices featured in the MATCH-ADTC manual. Such findings are reassuring—not only in that they provide additional support for providers’ frequent use of EBT practices (e.g., Palinkas et al, 2013; Park et al, 2015), but also in that they suggest that providers are adhering to the sequencing prescribed by the modular EBT (as a portion of youths prematurely terminated from treatment [Chorpita et al, 2016] and thus frequency of practice delivery is likely biased toward practices covered in the early stages of treatment).…”

Section: Discussionmentioning

confidence: 90%

“…Data were collected during the treatment phase of a community-based randomized clinical trial comparing a modular EBT with multiple community-implemented EBTs (e.g., Southam-Gerow et al, 2014) for children and adolescents presenting with problems in the areas of anxiety, depression, or conduct (see Chorpita et al, 2016, for more information). The treatment phase of this trial took place in Los Angeles, CA, from 2010 to 2014.…”

Section: Methodsmentioning

confidence: 99%

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Community-Based Providers’ Selection of Practices for Children and Adolescents With Comorbid Mental Health Problems

Park

Moskowitz

Chorpita

2016

Journal of Clinical Child & Adolescent Psychology

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The goal of this study is to explore providers’ patterns of implementation by investigating how community mental health providers selected therapy practice modules from a flexible, modular evidence-based treatment working with youths with comorbid mental health problems. Data were obtained from 57 youths, 5–15 years old, presenting with anxiety, depressive, and/or conduct problems and their 27 providers during their participation in an effectiveness trial involving a modular evidence-based treatment. Although all youths evidenced clinically elevated symptomatology in at least two problem areas, providers targeted youths’ comorbid problems with only about half of their study cases. Practice modules indicated for youths’ comorbid problems were typically used less frequently and with less depth relative to practice modules indicated for youths’ principal clinical problem and were often transdiagnostic in nature (i.e., designed to target more than one problem area). To determine whether providers’ decisions to target youths’ comorbid problems were systematic, multilevel, logistic regression analyses were conducted and revealed that youths’ pretreatment characteristics and time in therapy influenced providers’ patterns of module selection. Providers tend to use, but not exploit, the flexibility allowed by modular EBTs and to focus treatment on youths’ principal presenting problem. In addition, providers appear to make these practice choices in a systematic and rational manner, and whether and which choices are associated with improved outcomes is an important area of future study.

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Section: Discussionmentioning

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Community-Based Providers’ Selection of Practices for Children and Adolescents With Comorbid Mental Health Problems

Park

Moskowitz

Chorpita

2016

Journal of Clinical Child & Adolescent Psychology

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“…Participants were selected from the modular EBT condition (MATCH) of the Child STEPs in California study, a randomized clinical trial (RCT) conducted at three large community mental health agencies in urban California (Chorpita et al, 2017). Participants from the usual care condition of the trial were not included in the present study due to the inability to compare these providers’ responses to ELEs with ratings of ELE addressability using MATCH.…”

Section: Methodsmentioning

confidence: 99%

“…Youth were excluded if they had mental health concerns that could not be addressed with MATCH, including intellectual disability, autism, psychosis, recent suicide attempt, severe trauma, and juvenile justice involvement. Additional details and the flow of youth into the study according to CONSORT guidelines are reported in the original outcome paper (Chorpita et al, 2017). …”

Section: Methodsmentioning

confidence: 99%

“…Regarding theoretical orientation, 39% of providers identified as eclectic, 39% as cognitive-behavioral, 11% as humanistic/client centered, 6% as family systems, and 6% as other. Providers received a 5-day training in MATCH by the treatment developer, followed by individual weekly consultation with MATCH consultants over the course of the trial (Chorpita et al, 2017). …”

Section: Methodsmentioning

confidence: 99%

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“Teaching Moments” in Psychotherapy: Addressing Emergent Life Events Using Strategies From a Modular Evidence-Based Treatment

2019

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Emergent life events (ELEs) are unexpected, acute client stressors reported in psychotherapy sessions that are associated with reduced evidence-based treatment (EBT) integrity and client progress. As a potential solution, this study examined the extent to which ELEs could be appropriately addressed using existing EBT strategies. Participants were 34 low-income youth (ages 5–15, 50% male, 85% Latino) seen by 18 therapy providers in the modular EBT condition (MATCH) of a community effectiveness trial. MATCH experts rated descriptions of 75 ELEs from therapy sessions on how well they might be addressed clinically by any of MATCH’s 33 strategies for youth anxiety, depression, trauma, or conduct problems (i.e., “addressability”). MATCH-expert ratings were compared with observationally coded provider responses to ELEs. Results revealed that when assuming the presence of youth and caregiver in session, two-thirds of ELEs were identified as fully addressable and nearly all ELEs (96%) were partially addressable. ELEs related to family issues were most common but least likely to be addressable. Problem Solving and Relaxation skills could address the greatest percentage (87%) of ELEs. The most common supplemental content not explicitly prescribed in MATCH, but identified as necessary to fully address ELEs, was “assessing and empathic listening.” Provider responses often were incongruent with MATCH-expert raters regarding which strategies to use for which ELEs. In summary, most ELEs reported in a diverse community sample could be theoretically harnessed as “teaching moments” for skills within an existing, multi-problem EBT. However, providers may benefit from development of a structured resource to guide them in choosing the most effective response when these unexpected events arise.

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

et al. 2020

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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 disorderspecific 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, (continued) Key Points Question Is training in the Modular Approach to Therapy for Children (MATCH) associated with more use of empirically supported treatments, better clinical outcomes, and better service efficiency than usual care? Findings This randomized clinical trial found that training clinicians in MATCH was associated with high levels of adherence to empirically supported treatments (80....

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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.

Abstract: These results extend prior findings, supporting the effectiveness and efficiency of a modular, multifocus approach that incorporates monitoring and feedback relative to community implementation of evidence-based treatments. (PsycINFO Database Record

Cited by 169 publications

References 60 publications

Community-Based Providers’ Selection of Practices for Children and Adolescents With Comorbid Mental Health Problems

Community-Based Providers’ Selection of Practices for Children and Adolescents With Comorbid Mental Health Problems

“Teaching Moments” in Psychotherapy: Addressing Emergent Life Events Using Strategies From a Modular Evidence-Based Treatment

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

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