About This Network
One-fifth of the children in the United States have a diagnosable mental disorder—a sobering statistic. Even more sobering, however, is the fact that only about half of these children receive mental health care each year, and few are receiving treatments that have been shown scientifically to work. Although effective, evidence-based treatments are available, most are used mainly in university or research settings rather than in the clinics where the majority of children receive treatment. Thus, outcomes for children suffering from mental illness are not as good as they could be.
The MacArthur Foundation’s Research Network on Youth Mental Health Care worked to improve the quality of mental health care for children in clinical settings by encouraging and facilitating the adoption of evidence-based treatment. This was a tall order, requiring not only expertise in children’s mental health care, but also in identifying, understanding, and addressing the constellation of conditions and constraints under which clinicians operate.
By design, the Network included members whose expertise allowed them to explore such diverse areas as clinic organizational characteristics and the roles that family advocacy groups play in influencing treatment, as well as treatment decision-making guidance. Members also gathered high-quality qualitative feedback from clinicians regarding their experiences using evidence-based treatments.
Major Projects
To improve mental health care options for children, the Network designed and implemented the Child System and Treatment Enhancement Projects (ChildSTEPs). The initiative:
- Gathered information on the clinic settings where children are treated and the clinicians who provided that treatment,
- Designed new integrative methods for implementing evidence-based practices, and
- Developed tools to help clinicians make sound decisions during treatment.
The initial trial focused on children aged 7 to 13 who were receiving outpatient treatment for depression, anxiety, and disruptive conduct. The subsequent clinical trials expanded the range of participants to include children aged 6 to 15 and the treatment of trauma as well as the other three disorders.
A second project offered clinicians more tailored approaches to treatment. Many of the patients whom clinicians see suffer from more than one disorder, yet most of the evidence-based treatment protocols are designed to treat only one specific disorder, or a small homogeneous cluster. To address this shortcoming, Network members developed the Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH-ADTC). The approach allowed clinicians to tailor their treatment to the specific needs of their patients while still using evidence-based methods. Network members have also developed a web-based program that helped guide clinicians through treatment decisions.
Key Research
Building Bridges to Evidence-based Practice: The MacArthur Foundation Child System and Treatment Enhancement Projects (Child STEPs), by Sonja K. Schoenwald, Kelly Kelleher, John R. Weisz, (Administration and Policy in Mental Health and Mental Health Services Research, vol. 35, December 18, 2007).
One of a series of papers that describe the ChildSTEPs initiative, this article provides an overview of ChildSTEPs, its findings to date, and the development of tools for use at the clinic level.
Assessing the Organizational Social Context (OSC) of Mental Health Services: Implications for Research and Practice, by Charles Glisson, John Landsverk, Sonja Schoenwald, Kelly Kelleher, Kimberly Eaton Hoagwood, Stephen Mayberg, Philip Green (Administration and Policy in Mental Health and Mental Health Services Research, vol. 35, December 18, 2007).
This article provides an understanding of the organizational social context of mental health services to better account for differences in organizational characteristics in clinical trials and to design effective methods for improving services. Among the findings discussed is the influence of clinic culture on clinician morale and client treatment outcomes.
Driving with Roadmaps and Dashboards: Using Information Resources to Structure the Decision Models in Service Organizations, by Bruce F. Chorpita, Adam Bernstein, Eric L. Daleiden (Administration and Policy in Mental Health and Mental Health Services Research, vol. 35, November 6, 2007).
This article describes an example of a behavioral health reporting system designed to facilitate clinical and administrative use of evidence-based practices as well as the principles used in its design.
Testing Standard and Modular Designs for Psychotherapy Treating Depression, Anxiety, and Conduct Problems in Youth, by John R. Weisz et al. (Archives of General Psychiatry, vol. 69, no.3, March 2012).
This article describes a randomized effectiveness trial comparing the outcomes of youth receiving usual care, standard evidence-based treatment protocols, or treatment using the modular MATCH protocol. Findings show that the modular approach outperformed both usual care and standard evidence-based treatments on multiple clinical outcome measures.