How Can We Get Children and Teens Treatment That Works?
By Michael Southam-Gerow, PhD (APA Committee on Children, Youth, and Families)
More than 4 million children and teens have a serious mental disorder, but only 20 percent are getting the help they need. Did you know that it takes more than 15 years for an evidence-based treatment (EBT) to be used consistently in the community? That is about half a generation!
Our society still struggles to meet the mental health needs of our youth despite literally hundreds of studies demonstrating the potency of hundreds of treatments for those problems.
We need to invest time and dollars to disseminate and implement (i.e., effectively spread the use of) EBTs across diverse community practice settings. Whether you’re a researcher, therapist or parent of a child with a mental health problem, you can help EBTs get to the people that need them most.
What do therapists need to know?
EBTs are carefully-tested recipes, not computer code. Think of treatment manuals as a recipe, not strict computer code where one change can wreak havoc. Important ingredients are included, along with an order of assembling those ingredients. The recipes that work become EBTs. However, for individual cases, the proof is in the pudding. Cooks adapt recipes, perhaps shifting ingredients. However, we must measure the desired result, a successful outcome. If varying the recipe worked, great! If not, then perhaps we need to adhere to the recipe more closely.
EBT lists are evolving. These lists initially consisted of cognitive, behavioral, and cognitive-behavioral treatments because that was the nature of what we knew. However, as the field has advanced, more treatments have been tested and the list of EBTs now includes a wider variety of approaches. SAMSHA’s database of evidence-based programs or the Society of Clinical Child and Adolescent Psychology’s registry of Effective Child Therapy are good clearinghouses on the latest therapies.
What do researchers need to know?
Practice-based evidence is legitimate evidence. As we have learned more through dissemination and implementation efforts, we now know that information must flow both ways between research and practice. Partnering with therapists to learn what is working in usual care and improving what is not has become an important focus for researchers.
We share common goals. Effective partnerships begin with an attitude of respect toward therapists. Both therapists and clinical researchers dedicate their careers to promoting health and optimal functioning for children and teens. Researchers should remind themselves that we are all on the same team given the increasing focus on working with therapists and other stakeholders in partnership-based research efforts.
What do parents need to know?
Psychological treatment is not one-size-fits-all. There is evidence that specific treatments work well for some problems and less well for others. Different child/teen problems may require different treatments. It is important to remember that not all therapists will be equipped to provide all treatments. A frank conversation with a prospective therapist will help you to identify what he/she knows and does not know how to deliver.
Ask your therapist about evidence. Unlike drug treatments, psychological treatments are not developed by for-profit companies. That’s why the public sees very little marketing of psychological treatments and does not learn much about which treatments exist and work (and for which problems). Ask your child’s therapist to describe the treatment options available and what evidence there is to support their use. You can also consult SAMSHA’s database and the Effective Child Therapy registry BEFORE seeking treatment.