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).
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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...
