The Empirically Validated Treatments Movement: A Practitioner/Educator Perspective

In this commentary, I discuss the empirically validated treatments movement from the perspective of a practitioner and educator. I review the American Psychological Association (APA) Division 12 Task Force report ( APA, 1995 ) on empirically validated treatments, its effects, and its critics. I also consider the APA Division 29 Task Force report ( Norcross, 2001 ) on empirically supported therapy relationships and Westen and Morrison's (2001) metaanalysis of a set of efficacy studies. After highlighting the dilemmas that the empirically validated treatments movement creates for practitioners, I discuss how the endeavor of clinical practice differs from that of science and close by considering the definition of evidence-based practice adopted by the Institute of Medicine (2001) .     

Don't Mourn: Organize. Reviving Mental Health Services Research for Healthcare Quality Improvement

The structure, organization, management, and design of the mental health system are changing profoundly as new healthcare policies reshape its configurations. This special issue is a call to action for the mental health services research field. The articles represent an important attempt to identify specific concepts, constructs, and findings from psychosocial treatment research about fidelity and integrity of treatment and align them with healthcare quality. However, the current structure and processes for deriving quality indicators place other demands on the extant research base. These will challenge this migration unless changes are made in leadership around consistent measurement strategies, payment mechanisms to support quality, and attention to technological infrastructure development. The mental health services research field should be proactive. Pediatric issues need special attention, especially as applied to community‐based services for children and their families.     

Toward Large-Scale Implementation of Empirically Supported Treatments for Children: A Review and Observations by the Hawaii Empirical Basis to Services Task Force

This article details the context and findings of a review conducted by a state-established panel established to examine the efficacy and effectiveness of child treatments for Anxiety Disorders, Depression, Attention Deficit Hyperactivity Disorder, Conduct and Oppositional Disorders, and Autistic Disorder. The review emphasizes not only the specific results obtained, but also the process by which a university, Department of Health, and family partnership was established to address specific issues of relevance to statewide implementation of empirically based services. The review of treatment efficacy is consistent with the recent child treatment literature, and these findings were extended through a systematic cataloguing of effectiveness parameters across more than one hundred treatment outcome studies. The importance of such findings and the process by which they were obtained are discussed in the context of a statewide effort to improve mental health practice for children through the extension and application of much of the work by Division 12 of the American Psychological Association with respect to empirically supported treatments.     

"Validated" Treatments and Evidence-Based Psychological Services

In commenting on Carfield's critique of the report of the Task Force on Promotion and Dissemination of Psychological Procedures, some of his observations are amplified, before discussing three strategic questions: (a) Why do we focus on treatment methods? (b) What Is to be done about “unvalidated” methods? (c) How can evidence-based psychological treatment services be developed? It is concluded that a listing of “validated” treatments cannot serve as a rational and dependable basis for evidence-based psychological treatment services.     

Improving psychotherapeutic services via randomized clinical trials, treatment manuals, and component analysis designs

In order to advance the practice of psychotherapy and to discover how to improve on the benefits of psychotherapy, we propose that practitioners and researchers should rely more on the results of randomized clinical trials research. On the practice side, the routine use by practitioners of manuals for empirically supported treatments holds the promise of providing scientifically based clinical services to clients. On the research side, there is much to be gained in using component analysis designs to determine the effective elements of a treatment that has been established as empirically supported in randomized clinical trials. Once these elements are identified, the next version of the treatment manual then could highlight the crucial aspects of treatment to be included in clinical practice. thus further refining scientifically based psychotherapeutic services.     

Empirically supported treatments in pediatric psychology: bedtime refusal and night wakings in young children

OBJECTIVE: To review the literature for empirically supported treatments for bedtime refusal and night wakings in young children. METHODS: An extensive review of the literature resulted in the inclusion of 41 studies that were evaluated according to the criteria established by the Task Force on Promotion and Dissemination of Psychological Procedures (1995). RESULTS: Evidence exists indicating that extinction and parent education on the prevention of sleep problems can be considered well-established treatments. Furthermore, graduated extinction and scheduled awakenings are probably efficacious treatments, with positive routines a promising intervention. CONCLUSIONS: A discussion of effectiveness, treatment feasibility, cost-effectiveness, and methodological limitations of the studies is provided. Recommendations for future directions for research in the treatment of these two common sleep disorders are presented.     

深圳市外来工心理卫生服务需求研究

目的 调查深圳市外来工的心理需求,为开展心理卫生进社区提供依据和指导。方法 设计封闭式调查问卷,对深圳市宝安区的外来工心理卫生需求进行抽样调查。结果 外来工的心理卫生需求达81．5％,并且60．0％曾经考虑过心理求助,但是仅有5．0％真正寻求过心理服务。对于心理卫生服务,他们首选的方式是电话。结论 对外来工提供心理卫生服务很有必要性。     

Multiple-family group treatment as an effective intervention for children with psychological disorders

An estimated 20% of children suffer from psychological disorders and only 10-20% receive adequate treatment. A lack of empirically supported treatments is one reason why relatively few children receive treatment for their psychological difficulties. Multiple-family group treatment (MFGT) is an empirically supported intervention for adults with chronic mental illnesses that may be an effective treatment for children with psychological disorders. This article reviewed the adult MFGT model and its empirical support. The quantity and quality of child MFGT research was then reviewed. Child MFGT models are compared with one another and to the adult MFGT model. All studies provided initial support of MFGT as an appropriate treatment for childhood disorders. However, the child literature as whole was relatively limited, unfocused, and lacked replication. Suggestions for future research are made, focusing on a structured and scientific approach to establishing MFGT as an empirically supported intervention for children.     

Finding,evaluating, refining,and applying empirically supported treatments for children and adolescents

Structured child and adolescent treatments, tested through controlled clinical trials, have produced beneficial effects in hundreds of studies. By contrast, the limited pool or research on traditional clinical treatments raises doubts about their effectiveness. Thus, identification of empirically supported treatments may contribute something of real value to clinical practice and training. The Child Task Force report represents an important initial step in this direction. Here we offer both praise and critique, suggesting a number of ways the task force process and product may be improved. In addition, we suggest several ways to strengthen and enrich the clinical trials research available to the Task Force, emphasizing the need to test empirically supported treatments with referred youth in practice settings.     

Applying the criteria for empirically supported treatments to studies of psychosocial interventions for child and adolescent depression

Reviews the psychosocial treatment outcome studies for depressed children and adolescents and concludes that psychosocial interventions are effective at posttreatment and follow-up in reducing depressive symptoms/disorders in clinical and nonclinical samples of youth, regardless of treatment modality or extent of parental involvement. The article then examines the extent to which each study conforms to the guidelines set forth by the Task Force on Promotion and Dissemination of Psychological Procedures (1996) for well-established and probably efficacious interventions. Results of this analysis indicate only 2 series of studies that meet criteria for probably efficacious interventions and no studies that meet criteria for well-established treatments. Finally, the advantages and disadvantages of applying criteria for empirically supported treatments to identify good treatments for depressed youth are discussed, the importance of devising developmentally and culturally sensitive interventions targeted to the unique needs of each child is highlighted, and recommendations for future research that is informed by clinical practice and empirical findings are offered.     

Psychological Consultation in a Children's Hospital: An Evaluation of Services

The pediatric psychologist's role in children's inpatient medicalhospitals has rapidly expanded. Few studies have examined thetypes of referrals for psychological consultation or programevaluation of these services. This paper describes an archivalevaluation of the types of referrals received by a pediatricpsychology inpatient service over a period of 4 1/2 years andan evaluation of these services by physicians, nurses, and socialworkers. The survey of services indicated that the most frequentreferrals were for depression/suicide attempt, poor adjustmentto a chronic illness, and behavior problems. Medically relatedproblems accounted for 42% of all of the consults. Approximatelytwo-thirds of the children were referred for outpatient psychologicalservices. The pediatric psychology service was more likely tofollow, on an outpatient basis, children with medically relatedproblems. A 26-item questionnaire obtained an overall responserate of 48% and response rate of 84 and 60% for faculty andresident physicians having contact with the pediatric psychologyconsult service. The evaluation of the pediatric psychologyservice by physicians, nurses, and social workers indicatedoverall satisfaction with the services they received. The levelof satisfaction was strongly related to the level of diagnosticagreement between the physicians/nurses and psychologist. Thelowest level of satisfaction was on verbal and written feedback.Suggestion for further research was offered.     

The Process and Product of the Felix Decree Review of Empirically Supported Treatments: Prospects for Change

The report by Chorpita et al. on the Hawaii Empirical Basis to Services Task Force details a significant effort to improve services and enhance children's lives. Several elements distinguish this particular project to identify empirically supported treatments, notably the multi-disciplinary and consumer composition of the review committee and the mandated application of treatments identified in the process. The context of the lawsuit with the resulting Felix decree and the process of decision-making are important for public policy as well as for the science and practice of mental health service delivery. These considerations will likely enlarge the impact of this project.     

Services for children with diabetes

This is the first assessment of the services available and care received by children and adolescents with Type 1 Diabetes in the Republic of Ireland. Questionnaires were mailed to 19 centres in 2006 identified as providing care for children and adolescents with Diabetes. Replies were received from all centres. 29 consultants provide care for a reported 2040 patients in the 19 centres. 16 (50%) paediatricians surveyed expressed a special interest in Diabetes while 27 (94%) see children in a designated Diabetes clinic. The average caseload per whole-time-equivalent (WTE) Diabetes Nurse Specialists (DNS) is 162 patients and 416 patients per WTE Dietician. 13 of the 19 centres (70%) have no access to Psychology services. This review of children's diabetes services highlights the current deficiencies, particularly in relation to support staff, with respect to international recommendations. Improvements in resources to reduce long-term complications needs urgent addressing at both local and national levels.     

Empirically supported treatments in pediatric psychology: recurrent abdominal pain.

OBJECTIVE: To review the status of empirically supported treatments for recurrent abdominal pain (RAP). METHODS: We identified studies based on literature search and contact with experts in the field and evaluated studies based on guidelines modified from the criteria established by the Task Force on Promotion and Dissemination of Psychological Procedures. RESULTS: Nine published intervention studies were identified that fell into three distinctive approaches: operant procedures, fiber treatments, and cognitive-behavioral treatments. CONCLUSIONS: Operant procedures did not meet even the most lenient category (promising intervention) of the guidelines. Fiber treatment for RAP associated with constipation met the criteria for a promising intervention. Cognitive-behavioral treatment met the criteria for a probably efficacious intervention. We discuss implications and offer recommendations for future intervention research.     

Training in pediatric psychology: a survey of predoctoral internship programs

OBJECTIVE: To describe internship training in pediatric psychology and to determine its correspondence with the recommendations of the Society of Pediatric Psychology (SPP) Task Force on Training. METHODS: A survey based on the Task Force recommendations was sent to all internship programs that reported offering a major rotation in pediatrics. RESULTS: Opportunities in a wide range of assessment and intervention strategies were available. Training in disease process, medical management, and consultation/liaison with a variety of disciplines was also offered. Interns interacted with individuals from a range of developmental stages and ethnicities. Many professional issues were addressed. Experiences in research methods and prevention were less well represented. CONCLUSIONS: Despite some variability, experiences in a wide range of areas were offered by many programs in several of the training domains recommended by the SPP Task Force. However, there is room for improvement in training in research and prevention and health promotion.     

Examining Psychotherapy Processes in a Services Research Context

Interdisciplinary research efforts integrating services and interventions research methodologies are needed to improve the "real-world" clinical utility and impact of youth mental health research. "Hybrid" services and interventions research efforts can capitalize on the methodologic strengths of each research tradition in order to more rigorously examine and affect therapy processes in usual care youth mental health service settings. The goals of this article are to (a) identify the need for hybrid practice research on youth mental health care; (b) present a "case example" of a hybrid study, where child and family therapy processes are being examined in a usual care, practice-based context by a team of services researchers; (c) address the potential advantages and challenges of hybrid research; and (d) suggest promising areas for future hybrid research in youth mental health care.     

Exploring Empirically Supported Treatment Options for Children: Making the Case for the Next Generation of Cultural Research

In the last decade there has been increasing interest in empirically supported treatments for children. Chorpita et al. present an attempt to synthesize the knowledge base in the field and implementation of services. Placing the results in context, the authors make clear the need for an increased awareness of culture by researchers interested in empirically supported treatments. The construct of culture is explored as an active participant in the outcome literature. Furthermore, reasons for the lack of research into culture's influence on treatment outcomes is considered. Lastly, the importance of maintaining a dialog between the scientific and clinical service community is discussed.     

Behavioral and physiological indices related to BMI in a cohort of primary schoolchildren in Greece.

The purpose of this study was to investigate the differences between normal weight and overweight primary schoolchildren in terms of certain cardiovascular disease (CVD) risk factors and furthermore to identify behavioral correlates significantly affecting their body mass index (BMI). The sample consisted of 198 children with a mean age of 11.5 +/- 0.4 years (106 females and 92 males). Data was obtained on children anthropometry, plasma lipids, plasma glucose, dietary intake, cardiorespiratory fitness, and physical activity. Significant gender differences were observed for most of these parameters, with boys being more active and fit but also spending more time on sedentary activities and exhibiting higher intake of energy and fat compared to girls. Using the International Obesity Task Force's (IOTF) BMI cut-off points, the prevalence of overweight and obesity was estimated to be 35.6% and 6.7% among boys and 25.7% and 6.7% among girls, respectively. Overweight and obese children had higher levels of plasma triglycerides (TG) and total cholesterol to HDL-cholesterol (TC/HDL-C) ratio and lower levels of HDL-C and physical fitness compared to their normal-weight peers. Among the behavioral variables tested, only participation in organized sports, cardiorespiratory fitness, and TV watching were significantly correlated with BMI, while energy and fat intake were found to have no significant effect. The current study suggests that even in childhood, overweight and obesity are indicative of an unfavorable lipidemic profile. Among the behavioral parameters known to affect BMI, those found to exert a significant effect were organized physical activities, cardiorespiratory fitness, and TV watching, but not energy or fat intake.