Child STEPs in California: A cluster randomized effectiveness trial comparing modular treatment with community implemented treatment for youth with anxiety, depression, conduct problems, or traumatic stress.

OBJECTIVE: This study reports outcomes from a randomized effectiveness trial testing modular treatment versus multiple community-implemented evidence-based treatments for youth. METHOD: An ethnoracially diverse sample of 138 youth ages 5 to 15 (62 girls, 76 boys) whose primary clinical concerns involved diagnoses or clinical elevations related to anxiety, depression, disruptive behavior, and/or traumatic stress were treated by community therapists randomly assigned to 1 of 2 conditions: (a) modular treatment, which involved a single modular protocol (i.e., modular approach to therapy for children; MATCH) that allowed flexible selection and sequencing of procedures to fit the chosen treatment focus in the context of measurement feedback, and (b) community-implemented treatment (CIT), which was a county-supported implementation of multiple evidence-based practices for youth. RESULTS: Youth treated with MATCH showed significantly faster rates of improvement over time on clinical and functional outcomes relative to youth in the CIT condition and required significantly fewer sessions delivered over significantly fewer days. Caregiver-reported clinical improvement rates were significantly greater for MATCH (60%) versus CIT (36.7%). Further, youth in the CIT condition were significantly more likely to receive additional psychosocial treatment services and were significantly more likely to use a variety of psychotropic medications during the active treatment phase. CONCLUSIONS: These results extend prior findings, supporting the effectiveness and efficiency of a modular, multifocus approach that incorporates monitoring and feedback relative to community implementation of evidence-based treatments. (PsycINFO Database Record

Relationships between body satisfaction and psychological functioning and weight-related cognitions and behaviors in overweight adolescents.

PURPOSE: To examine how differences in body satisfaction may influence weight control behaviors, eating, weight and shape concerns, and psychological well-being among overweight adolescents. METHODS: A group of 103 overweight adolescents completed a survey assessing body satisfaction, weight control behaviors, eating-related thoughts and behaviors, importance placed on thinness, self-esteem, anger, and symptoms of depression and anxiety between 2004 and 2006. Logistic regression analyses compared overweight adolescents with high and low body satisfaction. RESULTS: Higher body satisfaction was associated with a lower likelihood of engaging in unhealthy weight control behaviors, less frequent fears of losing control over eating, and less importance placed on thinness. Overweight adolescents with higher body satisfaction reported higher levels of self-esteem and were less likely to endorse symptoms of depression, anxiety, and anger than overweight adolescents with lower body satisfaction. CONCLUSIONS: Adolescents with higher body satisfaction may be protected against the negative behavioral and psychological factors associated with overweight.

Differential weight restoration on olanzapine versus fluoxetine in identical twins with anorexia nervosa.

OBJECTIVE: No studies have compared the response to selective serotonin reuptake inhibitors and atypical antipsychotics in anorexia nervosa. This case study examines such a comparison. METHOD: This report describes a case of 12-year-old identical twins with anorexia nervosa, one of whom was treated with olanzapine and the other with fluoxetine, while undergoing family therapy. RESULTS: Twin A treated with fluoxetine went from 75 to 84.4% ideal body weight, while Twin B treated with olanzapine went from 72 to 99.9% ideal body weight over the course of 9 months. DISCUSSION: This case supports the need for adequately powered, controlled clinical trials to test the efficacy of olanzapine in adolescents presenting with anorexia nervosa.

The Old Solutions Are the New Problem: How Do We Better Use What We Already Know About Reducing the Burden of Mental Illness?

Kazdin and Blase (2011) propose that traditional models of delivering therapy require more resources than are available to address the scope of mental illness. We argue that finding new platforms and avenues for our existing treatments is a good start but that it is not enough. We contend that the field also needs to develop formal strategies to reorganize its increasing abundance of knowledge to address the scarcity of resources for its application. If we can better utilize our existing knowledge, treatment delivery and service resource allocation can become more efficient and effective. If the field continues with its almost singular emphasis on knowledge proliferation (e.g., developing new treatments), as opposed to knowledge management (e.g., developing new ways to design, apply, and organize existing treatments), the problem outlined by Kazdin and Blase cannot be solved.

Parent and family associations with weight-related behaviors and cognitions among overweight adolescents.

PURPOSE: To examine parent and family variables in relation to adolescent weight-control and eating behaviors, body satisfaction, and importance of thinness among overweight adolescents. METHODS: This study examined parent-reported use of weight-control behaviors (i.e., healthy and unhealthy behaviors, behavioral changes, other diet strategies), parent psychosocial functioning (i.e., depression, self-esteem, body satisfaction, importance of thinness), and family functioning (i.e., cohesion and adaptability) in relation to adolescent weight-control and eating behaviors, body satisfaction, and importance of thinness. Surveys were completed by 103 overweight (body mass index, >or=85th percentile) adolescents (aged 12-20 yr), and their parents. Height and weight were also measured. Linear regression equations were used for continuous outcomes and logistic regression equations for dichotomous outcomes. RESULTS: Adolescent report of lower body satisfaction and engagement in more "severe" or less healthy forms of weight-control behavior were associated with parent weight-control behaviors. Adolescent report of overeating was associated with lower scores of family cohesion and adaptability. Adolescent report of lower body satisfaction was positively associated with parent report of body satisfaction and self-esteem. Adolescent report of greater importance placed on thinness was associated with parent report of lower self-esteem. CONCLUSIONS: Findings indicate that several parent and family variables are associated with weight-control behaviors, episodes of overeating, and body satisfaction and importance of thinness among overweight adolescents. Parent weight-control behaviors and adolescent cognitions about body image may be important variables to target within intervention research and treatment programs for overweight youth.

The Child and Adolescent Symptom Inventory-Progress Monitor: a brief Diagnostic and Statistical Manual of Mental Disorders, 4th edition-referenced parent-report scale for children and adolescents.

The Child and Adolescent Symptom Inventory-Progress Monitor-Parent Form (CASI-PM-P) is a 29-item rating scale designed to evaluate symptom change for commonly referred child and adolescent disorders. Its intended applications include monitoring longer-term changes in clinical status and assessing intervention responsiveness. To enhance practicality, there is one version of the CASI-PM-P for all age groups with a common set of norms for both genders. Scoring procedures allow clinicians to assess whether observed symptom changes exceeded chance fluctuations. Using a clinical sample of 2,693 children ages 3-17 years, the 29 symptom-related items were identified that had the best item-to-total minus item correlations on the three age-appropriate scales of the Symptom Inventories. Item-to-total minus item correlations of similar magnitude were also obtained for those items with the standardization sample. In clinical samples, the CASI-PM-P scores had both high levels of internal consistency and test-retest reliability and were sensitive to change in a treated sample. Collectively, the findings support the reliability and validity of the CASI-PM-P as a measure of behavioral change in clinical settings, while continued research will be necessary to improve clinical utility and provide better documentation of the scale's strengths and weaknesses.

Predictors and consequences of early gains in child psychotherapy.

This study examined the predictors and consequences of early gains among children (n = 130) receiving psychotherapeutic treatment as usual for a variety of disorders. Classification tree analysis showed that not receiving Medicaid, plus receiving a medication consult, were associated with any early gain (i.e., reliable change on one or more clinical scales, with the early gain either remaining in the clinical range or moving to a subclinical level) within the first eight treatment sessions, but only Medicaid status predicted subclinical gains. Overall, patients showing a subclinical early gain showed better long-term improvement in treatment than those with no subclinical gain; patterns of change for those with and without any early gain were similar but with smaller differences between groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved).