INVITED COLUMN: EVIDENCE-BASED PRACTICE

Getting Better at Getting Them Better: Health Outcomes and Evidence-Based Practice Within a System of Care

The National Technical Assistance Network for Children’s Behavioral Health (TA Network) supports the development and implementation of Systems of Care (SOC) for youth with serious emotional disorders and their families in states, tribes, territories, and communities throughout the United States. The purpose of the current research was to conduct an evaluation of the TA Network to assess: The degree to which it has deployed research-based elements of TA; levels of participant satisfaction; types and scope of TA services provided; and systems-level outcomes. Study participants were drawn from a stratified random sample of SOC grant recipients who received technical support from the TA Network between 2013 and 2017. Results suggest that the TA Network has encompassed research-based elements of effective TA. Participants rated their interactions with the network very highly, and they accessed a wide variety of resources from the network. Finally, participants reported a variety of systems-level outcomes associated with TA Network support. Together, these findings underscore the importance of structuring TA systems to tailor support to fit with recipients’ needs, build positive, proactive relationships, and offer services of sufficient dosage. Given the lack of rigorous evaluations on provision of TA, future studies can confirm the degree to which such tailored approaches to TA result in increased satisfaction, more effective implementation of SOC principles, and ultimately improved outcomes for youth and families.

Many youth in treatment foster care (TFC) have been exposed to traumatic life events that are associated with negative health outcomes, yet few studies have examined how TFC programs are addressing the needs of trauma-exposed youth. This study used clinical data from 542 youth enrolled in TFC services within a statewide publicly funded mental health system from 2008 to 2018 to explore (a) how many youth receive trauma treatment, including youth diagnosed with PTSD, (b) to what extent common elements for youth trauma treatment are among the interventions employed during months when trauma was included as a treatment focus, and (c) clinician-reported trauma treatment progress. Only 34% of all youth in TFC, and 56% of youth diagnosed with PTSD, received treatment with any focus on trauma during the first six months of TFC. Therapists used a variety of therapeutic strategies during months when trauma was treated, some of which were consistent with the evidence-base for youth traumatic stress. Therapists reported 36% of youth with some trauma treatment focus made, at most, minimal improvement on trauma concerns during this time. Considerations for research and clinical practice in trauma-focused treatment foster care services are discussed.

This chapter provides an overview of evidence-based behavioral treatments for disruptive behavior disorders (DBDs) in young children. DBDs and theories of behavioral treatment in this age range are described. Next, evidence-based practice in psychology is defined, followed by a basic description of behavioral parent training with emphasis on its efficacious components. Later, the inclusion criteria for behavioral approaches in this chapter are explicated, and major models of therapy in this domain are summarized. Then, parent-child interaction therapy (PCIT) is used as an exemplar to compare the similarities and differences among behavioral treatments for DBDs in young children. Finally, future directions are discussed.