Week 12: Dissemination

Question 1

Dissemination

Answer 1

 Many youth will experience significant mental health problems
 We have treatments of demonstrated efficacy for a number of these challenges

Question 2

Treatment Efficacy versus Effectiveness

Answer 2

 Treatments have demonstrated efficacy
 Efficacy: Can this treatment work?
 Tested in RCTs
 Patients recruited for studies who often do not represent “real world”
presentation
 Therapists who are highly trained to administer an intervention
 Different conditions then we see in practice
May have graduate students ONLY doing this and so have lots of time to focus on it - unrealistic in the real world

 Treatments have demonstrated efficacy
 Efficacy: Can this treatment work?
 Tested in RCTs
 Patients recruited for studies who often do not represent “real world”
presentation
 Therapists who are highly trained to administer an intervention
 Different conditions then we see in practice

Question 3

Are Evidence-Based Interventions

Being Used in Usual Care?

Answer 3

 Not as widely as you would think
 Treatment in community is much more eclectic and based upon therapist’s personal preferences
 For example, therapists in community-mental health clinic reported using more psychodynamic techniques during treatment of depression than cognitive and behavioral techniques (Weersing & Weisz, 2002)

Even though at the time CBT had a stronger evidence base vs depression

Question 4

Why Not?

Answer 4

 Efficacy versus effectiveness
 Concerns about treatments in the real world
 Complex case presentations
 More severe psychopathology
 Cultural differences
 Rapport - therapists worry they will lose rapport by being to manualized
 Manuals too inflexible

Question 5

Bridging the gap

Answer 5

 Bridging the gap between research and practice (researchers are responsible for this)
 Disseminating evidence-based treatments and assessments
 Recall that evidence-based assessments (e.g., structured and semistructured interviews) perform better than unstructured interviews
 Will be significant advantages to incorporating those in treatment

Question 6

Is Evidence-Based Psychotherapy for Youth
Depression Associated with Greater Improvement in
Symptoms?

Answer 6

 Compared:
 Treatment as usual in community clinics
 “Gold standard” treatment – CBT administered in randomized clinic
trials

They finish at the same place BUT the evidenced method gets there faster

ALSO depression naturally remits. It is possible that the non evidence based group was just due to this remittance

Question 7

Evidence-Based Psychotherapy

versus Usual Care

Answer 7

 Meta-analysis
 Studies comparing evidence-based treatments to treatment as
usual (usual care)
 E.g., MST versus care as usual
 Usual care defined as “psychotherapy, counseling, or other nonmedication interventions provided through outpatient clinics, public programs, and agencies or residential facilties:
 Meta-analysis found that youth receiving EBTs showed greater
improvement that youth receiving usual care
 But ….
 The difference was not large
 EBP may be less efficacious than we thought and usual care may be
more efficacious
 Difference between EBP and usual care was smaller when
symptoms were more severe
 When all participants in the sample met criteria for a diagnosis, the
difference between EBP and usual care was not significant
 Difference between EBP and usual care was the same for White
youth and racialized youth

Maybe cos the participants of the studies were better in the first place

We need to design studies to reflect real world conditions

Question 8

Summary

Answer 8

 Many youth will experience significant psychological symptoms
 Basic research is ongoing to try to understand etiology and maintenance of those problems
 Apply research to developing more effective interventions
 Testing under real-world conditions
 Dissemination of evidence-based interventions

How do we make it better and get it out there?