Cognitive–behavioral therapy versus usual clinical care for youth depression: An initial test of transportability to community clinics and clinicians.

Abstract

Community clinic therapists were randomized to (a) brief training and supervision in CBT for youth depression or (b) usual care (UC). The therapists treated 57 youths (56% girls), aged 8-15, 33% Caucasian, 26% African-American, and 26% Latino; most youths were from low-income families; all had DSM-IV depressive disorders (plus multiple comorbiditities). All youths were randomized to CBT or UC and treated until normal termination. Session coding showed more use of CBT by CBT therapists, more psychodynamic and family approaches by UC therapists. At Address inquiries to John Weisz, Department of Psychology, Harvard University, William James Hall, 33 Kirkland Street, Cambridge, MA 02138, or via to jweisz@jbcc.harvard.edu. 5 When group variances differed significantly (p < .05) and violated the equal variance assumption of the standard t-test, we used the relatively robust Welch statistic and its associated degrees of freedom (Welch, 1951;Blalock, 1972). Publisher's Disclaimer:The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at http://www.apa.org/journals/ccp/ NIH Public Access Author Manuscript J Consult Clin Psychol. Author manuscript; available in PMC 2010 December 24. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript post-treatment, depression symptom measures were at sub-clinical levels, and 75% of youths had no remaining depressive disorder, but CBT and UC groups did not differ on these outcomes. However, compared to UC, CBT was (a) briefer (24 vs. 39 weeks), (b) superior in parent-rated therapeutic alliance, (c) less likely to require additional services [including all psychotropics combined and depression medication in particular], and (d) less costly. The findings showed advantages for CBT in parent engagement, reduced use of medication and other services, overall cost, and possibly speed of improvement-an hypothesis that warrants testing in future research. Keywordsdepression; children; adolescents; youth; cognitive-behavioral therapy; community clinicAdvocates for evidence-based treatments (EBTs; e.g., National Advisory Mental Health Council Workgroup, 2001; Office of the Surgeon General, 1999General, , 2004 President's New Freedom Commission, 2003) have made a case for transporting these treatments to a broad array of everyday practice contexts. This perspective may make sense, in principle. However, before major resources are devoted to large-scale dissemination, it may be wise to study the implementation process, to learn what steps are needed to transport these treatments effectively.As several researchers have suggested...

Youth top problems: Using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy.

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Odd Couple? Reenvisioning the Relation Between Science and Practice in the Dissemination-Implementation Era

“…An additional effectiveness trial feature for which we have argued (Weisz & Gray, 2008;Weisz et al, 2006) is random assignment of clients to the EBP being tested vs. representative usual care; this addresses the critical question of whether the EBP actually improves outcomes relative to the intervention that is normally provided in the absence of the EBP. There is a growing body of effectiveness trial evidence with an array of Science and Practice of Dissemination and Implementation 15 treated problems and disorders and across a broad client age range (e.g., Addis et al, 2004;Weisz et al, 2009). In general, those effectiveness trials in which EBPs are tested against usual care have shown the effect size drop-off described in our earlier section on the implementation cliff.…”

Bridging the Research-Practice Divide in Youth Psychotherapy: The Deployment-Focused Model and Transdiagnostic Treatment

“…We have participated in this movement, but along the way we encountered 'an inconvenient truth': Treatments that fare well in traditional RCTs do not always seem quite so strong when implemented in everyday clinical practice. We heard this in conversations with practitioners, and we found it to be true in our own effectiveness trials testing cognitive behavioral therapy (CBT) for anxiety and for depression against usual clinical care in youth community mental health clinics [Southam-Gerow et al, 2010;Weisz et al, 2009]. We also conducted 2 meta-analyses of RCTs that had tested youth ESTs in more clinically representative contexts, pitting the ESTs against usual care [Weisz et al, 2006.…”