Embracing Scientific Humility and Complexity: Learning “What Works for Whom” in Youth Psychotherapy Research

2021 ◽  
Author(s):  
Michael C Mullarkey ◽  
Jessica L. Schleider

Clinical psychological scientists have spent decades attempting to understand “what works for whom” in the context of youth psychotherapy, toward the longstanding goal of personalizing psychosocial interventions to fit individual needs and characteristics. However, as the articles in this Special Issue jointly underscore, more than 50 years of psychotherapy research has yet to help us realize this goal. In this introduction to the special issue, we outline how and why “aspiration-method mismatches” have hampered progress toward identifying moderators of youth psychotherapy; emphasize the need to embrace etiological complexity and scientific humility in pursuing new methodological solutions; and propose individual and structural strategies for better-aligning clinical research methods with the goal of personalizing mental health care for youth with diverse identities and treatment needs.

2014 ◽  
Vol 23 (4) ◽  
pp. 337-344 ◽  
Author(s):  
T. Burns

Mental health care in the second half of the 20th century in much of the developed world has been dominated by the move out from large asylums. Both in response to this move and to make it possible, a pattern of care has evolved which is most commonly referred to as ‘Community Psychiatry’. This narrative review describes this process, from local experimentation into the current era of evidence-based mental health care. It focuses on three main areas of this development: (i) the reprovision of care for those discharged during deinstitutionalisation; (ii) the evolution and evaluation of its characteristic feature the Community Mental Health Team; and (iii) the increasing sophistication of psychosocial interventions developed to support patients. It finishes with an overview of some current challenges.


2020 ◽  
Vol 45 (6) ◽  
pp. 633-642
Author(s):  
Elizabeth R Wolock ◽  
Alexander H Queen ◽  
Gabriela M Rodríguez ◽  
John R Weisz

Abstract Objective In research with community samples, children with chronic physical illnesses have shown elevated anxiety and depressive symptoms, compared to healthy peers. Less is known about whether physical illnesses are associated with elevated internalizing symptoms even among children referred for mental health treatment—a pattern that would indicate distinctive treatment needs among physically ill children receiving mental health care. We investigated the relationship between chronic physical illness and internalizing symptomatology among children enrolling in outpatient mental health treatment. Method A total of 262 treatment-seeking children ages 7–15 and their caregivers completed a demographic questionnaire, Child Behavior Checklist, and Youth Self-Report during a pre-treatment assessment. Physical illnesses were identified through caregiver report. Results There was no overall association between the presence/absence of chronic physical illness and parent- or child-reported symptoms. However, number of chronic physical illnesses was related to parent- and child-reported affective symptoms. Children with two or more chronic physical illnesses had more severe depressive symptoms than those with fewer physical illnesses. Conclusion Having multiple chronic illnesses may elevate children’s risk of depression symptomatology, even in comparison to other children seeking mental health care. This suggests a need to identify factors that may exacerbate depression symptoms in physically ill children who are initiating therapy and to determine whether different or more intensive services may be helpful for this group. The findings suggest the potential utility of screening for depression in youth with chronic physical illnesses, as well as addressing mental and physical health concerns during treatment.


2013 ◽  
Vol 1 (2) ◽  
pp. XXXX-XXXX ◽  
Author(s):  
C Dowrick ◽  
C Chew-Graham ◽  
K Lovell ◽  
J Lamb ◽  
S Aseem ◽  
...  

BackgroundEvidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.Aim and objectivesOur aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.Methods and resultsExamination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.ConclusionsFurther research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.Study registrationCurrent Controlled Trials ISRCTN68572159.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  

Abstract Over the past decade, the global population of forcibly displaced people reaching a record high by growing to over 70 million in 2018. The largest group of refugees worldwide currently are the Syrians, and most of them have fled to countries neighboring Syria (e.g., Turkey, Jordan and Lebanon), whereas smaller but significant numbers of refugees fled to European countries. Over 50% of Syrian refugees are children, in many cases unaccompanied by their family. Increased rates of common mental disorders, including anxiety, depression, and posttraumatic stress disorder (PTSD) have been documented in various refugee populations. Much less is known about the prevalence of other common mental health problems, such as substance use. In order to effectively address the mental health needs of Syrian refugees, increasing knowledge about self-identified problems and cultural idioms of distress within the Syrian community is imperative. This may also facilitate the development of effective mental health awareness programs within refugee communities. Further, the refugee crisis imposes highly challenging demands on health systems in Europe and the Middle East. Within the Middle East, there is a great lack of mental health workforce, and limited availability of evidence-based interventions. Within Europe, specialized mental health care services for refugee populations are available, yet the number of Arabic-speaking professionals is very limited. Other barriers to seeking and continuing mental health care for refugees include the use of interpreters, lack of culturally adapted interventions for a range of mental health problems, and stigma within refugee communities. Learning from evidence from low- and middle-income settings, task-sharing interventions delivered by non-professional helpers in the community instead of within specialized mental health care facilitate access to care. Within European settings, they can be successfully integrated within stepped care models used as a public mental health care strategy to reduce costs and increase mental health care use and continuation for refugee populations. In order to address the mental health needs of Syrian refugees, increasing knowledge about self-identified problems and cultural idioms of distress within the Syrian community is imperative. In addition, scalable task-sharing interventions addressing these problems should be developed and evaluated. This international workshop will focus on 1) self-identified problems and idioms of distress within the Syrian refugee community to inform the development of targeted psychosocial interventions; and 2) the effects of novel scalable psychosocial interventions to address common mental disorders across the health systems within Europe (Turkey and the Netherlands) and the Middle East (Jordan). The presenters are Naser Morina (Switzerland), Jutta Lindert (Germany), Richard Bryant (Australia), Dr. Ceren Acarturk (Turkey) and Marit Sijbrandij (the Netherlands). Key messages Scalable psychosocial interventions can successfully be implemented across refugee settings in the Netherlands, Turkey, the Netherlands and Jordan to address common mental disorders. To address major mental health concerns within refugee communities, culturally concepts of distress and general wellbeing indicators should be considered.


2013 ◽  
Vol 22 (2) ◽  
pp. 111-117 ◽  
Author(s):  
M. Ruggeri ◽  
A. Lasalvia ◽  
C. Bonetto

This Editorial addresses the crucial issue of which research methodology is most suited for capturing the complexity of psychosocial interventions conducted in ‘real world’ mental health settings. It first examines conventional randomized controlled trial (RCT) methodology and critically appraises its strengths and weaknesses. It then considers the specificity of mental health care treatments and defines the term ‘complex’ intervention and its implications for RCT design. The salient features of pragmatic RCTs aimed at generating evidence of psychosocial intervention effectiveness are then described. Subsequently, the conceptualization of pragmatic RCTs, and of their further developments – which we propose to call ‘new generation’ pragmatic trials – in the broader routine mental health service context, is explored. Helpful tools for planning pragmatic RCTs, such as the CONSORT extension for pragmatic trials, and the PRECIS tool are also examined. We then discuss some practical challenges that are involved in the design and implementation of pragmatic trials based on our own experience in conducting the GET UP PIANO Trial. Lastly, we speculate on the ways in which current ideas on the purpose, scope and ethics of mental health care research may determine further challenges for clinical research and evidence-based practice.


2016 ◽  
Vol 33 (S1) ◽  
pp. S6-S6
Author(s):  
T. Becker ◽  
U. Guehne ◽  
S. Riedel-Heller

BackgroundPsychosocial interventions are essential tools in mental health care and rehabilitation. A range of interventions relevant to rehabilitation that are covered in a German DGPPN S3 guideline on psychosocial interventions are discussed.MethodsLiterature search and (mostly) systematic reviews were performed for a range of psychosocial interventions.FindingsMilieu therapy (MT) includes measures that impinge on therapeutic milieu/atmosphere in joint professional/user groups in the course of treatment. MT provides a context in which psychosocial interventions can be implemented. There is evidence of its effectiveness in improving mental health outcomes. Peer involvement (PI) and peer support are supported by promising evidence as innovative interventions in mental health care. Findings on case management (CM) are inconsistent. There are difficulties in defining CM. CM strengths include treatment satisfaction and continuity of care. With respect to integration in the labour market for people with severe mental illness supported employment (SE) has been shown to be more effective in achieving job placement. A proportion of SE users fail to find jobs on the general labour market. Other types of work rehabilitation are required, and there is room for pre-vocational training interventions.DiscussionPsychosocial interventions are strong interventions. The strength of the evidence is varied. The use of psychosocial interventions rests on experience, evidence and ethics.ConclusionsPsychosocial interventions are indispensable in building mental health care systems. Vocational interventions and residential services are mandatory. Peer involvement could help in moving mental health services forward.Disclosure of interestThe authors have not supplied their declaration of competing interest.


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