Child therapy intervention increases clinicians' use of empirically supported treatments

A modular therapy intervention for children increased clinicians’ adherence to empirically supported treatments but did not improve clinical outcomes, according to results of a randomized clinical trial published in JAMA Network Open.

“Mental health problems in children and adolescents are common and persistent,” Sally N. Merry, MD, of the department of psychological medicine, School of Medicine at University of Auckland Faculty of Medical and Health Sciences, and colleagues wrote. “There are effective therapies available; however, delivering these therapies in clinical practice has been challenging.

“This is partly because the evidence is primarily available for single disorders or a homogeneous cluster of problems, whereas clinicians are faced with comorbid presentations that may change in focus during therapy,” they added. “Clinicians may adopt a pragmatic but eclectic approach, unintentionally eroding the impact of carefully designed best clinical practice.”

Results of prior studies suggested that the Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH) was more effective and efficient than usual care. MATCH includes empirically supported treatment components for flexible management of common mental health problems, whereas usual care includes psychological therapies and case management. Both may include pharmacotherapy, according to the investigators.

In the current study, Merry and colleagues aimed to determine whether using MATCH to train clinicians resulted in increased use of empirically supported treatment and better clinical outcomes vs. usual care among 206 individuals who accessed child and adolescent mental health services in five regions of New Zealand and 65 clinicians. The researchers randomly assigned the clinicians to undertake MATCH training or to deliver usual care, and they assigned young people with anxiety, depression, trauma-related symptoms or disruptive behavior to MATCH or usual care. Primary outcomes included trajectory of change of clinical severity, according to weekly ratings on the Brief Problem Monitor (BPM); adherence to empirically supported treatment, according to audio recordings of therapy sessions coded using the Therapy Integrity in Evidence Based Interventions: Observational Coding System; and service delivery efficiency, according to duration of therapy and clinician time.

Results showed a mean slope of –1.04 with a 1-year change of 6.12 in the MATCH group vs. –1.04 with a 1-year change of 6.17 in the usual care group. The BPM total for youths had a mean slope of –0.74 with a 1-year change of 4.35 in the MATCH group vs. –0.73 with a 1-year change of 4.32 in the usual care group. According to results of intention-to-treat primary analyses, there was no difference in clinical outcomes or efficiency despite significantly higher adherence to empirically supported treatment content among the MATCH group vs. the usual care group. Further, for service delivery efficiency, the researchers reported no differences in total face-to-face clinician time between the MATCH group vs. the usual care group or the overall therapy duration between the groups.

“These findings suggest that a brief 5-day training in MATCH resulted in a significant increase in the delivery of [empirically supported treatments],” Merry and colleagues wrote. “The lack of change in clinical outcome in our study despite a significant change in delivery of [empirically supported treatments] and in contrast to previous studies may be partly explained by the high level of [empirically supported treatment] delivered by [usual care] clinicians. The question of how [empirically supported treatment] fidelity is related to clinical outcomes, and the part played by nonspecific factors such as warmth and empathy, warrants further attention.”