Promoting Youth Well-Being Through Psychotherapy: Redesigning Treatments for Real-World Clinical Care
Air Traffic Control, Serve and Return, Service Delivery
Dr. John R. Weisz, Judge Baker Children's Center, Harvard University, examines empirically tested treatments to enhance self-regulation and adaptation in youths who have mental health problems and disorders. The treatments focus on enhancing three forms of regulation: affective, cognitive, and behavioural. These evidence-based treatments (EBTs) have shown respectable effects in randomized controlled efficacy trials in which treatment conditions are optimized for research. However, the EBTs do not fare so well when compared to usual clinical care with clinically referred youths treated in everyday practice conditions. One reason may be that referred youths are often more complex than the treatments designed to help them. To address this challenge, Dr. Weisz's group has developed an agile, transdiagnostic intervention approach, the Child STEPs Treatment Model. STEPs uses a modular treatment protocol derived from the psychotherapy evidence base and guided by decision flowcharts. Navigation through treatment is informed by a web-based system that monitors each youth's treatment response week-by-week. A multi-site randomized trial of this system, applied to youths with anxiety, depression, and conduct problems, showed that STEPs outperformed both usual clinical care and standard EBTs, on measures of youth self-regulation and adaptation and on clinician ratings of satisfaction with the treatment provided. The STEPs approach may provide a bridge linking the rich evidence base of clinical science to the complexity of referred youths in everyday clinical care. However, key questions about the biology underlying the treatment effects remain unanswered.