Developing and Implementing Randomized Effectiveness Trials in General Medical Settings

This article discusses the development of two mental health services research programs: one targeting depression treatment in primary care and the other early intervention for posttraumatic stress disorders in acute care. Both programs have used the randomized effectiveness trial to assess the delivery of empirically supported psychotherapeutic and psychopharmacologic interventions in these general medical settings. This article explores the fellowship training, clinical experiences, and conceptual frameworks that have informed the progression of the two research programs. Specific modifications to the traditional randomized clinical trial design employed in the effectiveness trials are discussed. This article concludes with reflection on intervention development trajectories and interdisciplinary team compositions that may facilitate the development of mental health interventions that both derive from the best scientific evidence and can be feasibly delivered in real-world treatment settings.