chapter 13 introduction to clinical psychology, third canadian edition by john hunsley and catherine...
TRANSCRIPT
Chapter 13
INTRODUCTION TO CLINICAL
PSYCHOLOGY, THIRD CANADIAN EDITION
by John Hunsley and Catherine M. Lee
• Questions
• Who is the client in psychological services for childhood disorders?
• Landmarks in the evolution of evidence-based psychological services for children and adolescents
• Examples of evidence-based treatments
• Efficacy, effectiveness, and the dissemination of evidence-based treatments
• For next class
Outline
Who is the client in psychological services for children and adolescents?
1 in 5 children have a mental disorder (World Health Organization, 2007)
Half of all mental disorders begin before the age of 14 (World Health Organization, 2007)
Median age of onset of: impulse control problems—11 years anxiety disorders—11 years depression—14 years
(Kessler et al. 2005; Merikangas et al. 2010)
Who Needs Services?
Most disorders are chronic and persist into adulthood
Comorbidity is very common; 40% with 1 diagnosis have a 2nd diagnosis(Merikangas et al., 2010)
• Associated with
Substance abuse Suicide School problems and drop-out Delinquency Unprotected sex
Consequences of Problems in Youth
Child, his/her friends and siblings
Parents, caregivers
School, healthcare, and criminal justice
Burden of Child and Youth Mental Disorders
Only 1 in 3 adolescents requiring services for clinical problems received
them (Costello, Copeland, Cowell, & Keeler, 2007)
Only half of children and adolescents who begin psychological services
complete them (Nock & Ferriter, 2005)
Limited evidence that treatment as usual is helpful (e.g., Weiss et al.,1999)
Psychological Treatments: The Bad News
• Parental psychopathology• Parental isolation• Family conflict
Issues of Premature Termination/Drop-out
Landmarks in the Evolution of EB Psychological Services for Children and Adolescents
• 1000s of studies
• Different methodologies
• Contradictory findings
• Lag in development and evaluation of services for children and youth compared to services for adults
Evidence for Services for Children and Youth?
Does therapy work?
What therapy works for this problem?
What therapy works for this problem in this context?
• Levitt reviews– 1957 18 studies
– 1963 22 studies
– Echoes Eysenck’s review for adults; no evidence of efficacy, as 67-73% improved without treatment
• Casey & Berman (1985)
• First meta-analysis of 79 studies– Comparable effect sizes to adult; larger effect sizes for behavioural
approaches than for other orientations
Does Therapy Work?
• Kazdin, Bass, Ayers, & Rodgers (1990)– Although treatment works, samples in RCTs dissimilar to clinical
practice
• Weisz, Weiss, Alicke, & Klotz (1987)– Larger effect for behavioural approaches
• Weisz, Weiss, Han, & Granger (1995)– Larger effects for behavioural approaches; effects sustained at
follow-up
Does Therapy Work?
• Commissioned reviews designed to set out criteria by which research will be evaluated and to produce clear recommendations
• Focus on specific disorders or problems
Which Therapy Works for this Disorder?
• APA Division 12 (Clinical) Task Force on Promotion and Dissemination of Psychological Procedures– Chambless & Ollendick, 1999
• Society of Clinical Child and Adolescent Psychology (APA Division 53)– Journal of Clinical Child Psychology 1998– Journal of Pediatric Psychology, 1999– Journal of Clinical Child and Adolescent Psychology (JCCAP), 2008
Which Therapys Work for this Disorder?
Silverman & Hinshaw edited special issue (2008) on efficacious treatments for:
– Anxiety disorders: social anxiety, phobias, obsessive compulsive disorder;
– Attention-deficit/hyperactivity disorder– Autism– Depression– Disruptive behaviour disorders– Exposure to trauma– Substance abuse disorders
JCCAP
• Nathan and Gorman (1998; 2002; 2007)– Treatments that work
• Fonagy & colleagues (2002; 2005)– What works for whom?
• Hawaii Department of Health Task Force– Chorpita (2002)
What Works for this Disorder? Interdisciplinary Reviews
Clinical practice guidelines
Set standards based on reserarch
Based on research
Require regular updates
Influence services that are funded
• Disruptive behaviour disorders– Parent Management Training (PMT)
– Multisystemic Therapy (MST)
• Adolescent depression– Coping with Depression in Adolescence
Examples of Evidence-Based Treatments
Efficacy, Effectiveness, and Dissemination
Unknown how many receive treatments that are evidence-based (Kazdin, 2008)
Do results from RCTs generalize to regular clinical settings?
Can efficacious treatments be transported to other countries?
Can regular clinicians achieve similar results?
Do EBTs Work in Real World Settings?
Identify effectiveness
studies
Identify meta-analyses of
RCTs
Compare on two clinically
relevant benchmarks
To see whether EBTs can be transported to real-world settings….
• Internalizing disorders: n = 394 – Depression n = 3 studies
– Mixed anxiety n = 2 studies
– OCD = 2 studies
• Completion: over 80%
• Recovery: 50-75%
Effectiveness: Lee, Horvath, & Hunsley (2013)
• Disruptive behaviour disorders– N = 1118 parents
– n = 13 studies
• Completion: around 80%
• Improvement: moderate effect sizes
Effectiveness: Lee et al. (2013)
• Chorpita & Daleiden (2009) reviewed 322 randomized controlled trials of treatments for children and youth– Identified clusters of treatment strategies shown to be efficacious across
many trails, for various disorders
– Advocate using such strategies to individually tailor the treatment to client needs
• Weisz et al. (2012) developed modular treatment options for depression, anxiety, and conduct problemss– Modular treatment out-performed treatment as usual and specific EBTs for
depression, anxiety, and conduct problems
– Caveat—single trial requiring replication
Modular Treatment Options
For next class…
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