Managing In-Session "Surprises:" Provider Responses to Emergent Life Events during Evidence-Based Treatment Implementation.

This study aimed to: (1) pilot a psychotherapy coding system for provider responses to emergent life events (ELEs; unexpected events that have a significant negative impact on the client), (2) examine the impact of ELEs on evidence-based treatment (EBT) delivery in community settings. Raters coded 30 randomly-sampled EBT session recordings with and without reported ELEs. Inter-rater reliability and validity for the system were generally high. When an ELE occurred, providers were significantly less likely to deliver the EBT, and when they did, they rarely linked the EBT to the event. Findings highlight the potential for ELEs to disrupt EBT implementation.

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

Brief report: illness factors and child behavior before and during pediatric hospitalization.

OBJECTIVE: Little is known about factors predicting in-hospital adjustment in children with chronic illnesses or about risk/protective factors for in-hospital behavior compared to out-of-hospital behavior. This study investigated the relationship between illness factors (chronicity and severity) and child adjustment in and out of the hospital. METHODS: Parents and nurses completed questionnaires about in-hospital and home behavior for a sample of 85 hospitalized children. RESULTS: In the hospital, children with acute illnesses demonstrated more internalizing behavior problems than children with chronic illnesses. Children with life-threatening illnesses had more internalizing and externalizing problems than children with non-life-threatening illnesses. Out of the hospital, children with chronic illnesses demonstrated more internalizing problems and a trend toward more externalizing problems than healthy children who later developed acute illnesses. Out of hospital behavior problems were unrelated to illness severity. CONCLUSIONS: Results suggest that different illness factors may predict in-hospital as compared to out-of-hospital behavioral adjustment.