My major ongoing program of research focuses on how public child and adolescent mental health services are organized and delivered, how such services address complex needs (e.g. comorbidity, interagency coordination), how these services and service arrangements can be improved, and how these services and associated youth outcomes advance our understanding of what works in children’s mental health. My group brings a strong commitment to the application of evidence-based practices (EBPs) in community-based services. That said, we focus on the intersection of EBPs and community treatment research, which has led to new insights about both areas of research. By taking this joint focus, we think we are finding much better ways to help children and their families while also furthering our understanding of effective treatment mechanisms and moderators. We are explicitly focused on strengthening the linkage between research and practice by bringing a strong scientific analysis to community treatment. Our focus is explicitly trans-diagnostic and grounded in the day-to-day realities of public mental health practice.
Over the last 12 years we have developed an extensive data-set on community mental health services delivered to over 5000 youth using valid and reliable measures of treatment and treatment progress. From this we have published a variety of studies, nearly always with student first authors. Current projects focus on differential youth outcomes as a function of the extent practices derived from the evidence base are used; how practices and treatment targets are organized and how these differ depending on youth problems; How therapist attack specific clinical problems and the extent to which such decisions enhance outcomes; whether and to what extent treatment follows known patterns of psychopathology (e.g. for disruptive behavior problems or for sexual misconduct problems); whether and to what extent externalizing problems are given precedence over internalizing problems in community treatment and the implications of such a choice; how best to treat youth with both internalizing and externalizing problems; whether, when and how implemented evidence-based practices produce better treatment outcomes than treatment as usual; whether a focus on positive psychology targets are associated with better outcomes in child treatment; patterns of treatment gain in youth served by public mental health treatment across residential and in-home services; predicting and preventing treatment failure; how and how much the use of treatment progress monitoring improves outcomes, and the extent to which client outcomes differ across therapists and/or organizations. There are many other projects in the conceptual and/or planning phases and there are more good ideas and study opportunities than we will ever be able to complete.
Two major projects are in the planning stage. The first asks whether the selection of treatment targets (rather than or in addition to the use of specific therapeutic practices) predicts greater functional improvement and overall treatment response. The current debate about what works in treatment is nearly exclusively focused on “what is done in therapy” and virtually ignores “what is targeted in therapy”. Using data from over 80,000 monthly records of community treatment, we will examine youth outcomes as a function of treatment target selection. We have already found that targeting mood related problems in youth with comorbid mood and disruptive behavior problems is associated with greater disruptive behavior improvement. The second project is based on our (and some others’ findings) that the use of more and more varied therapeutic practices in community settings is associated with better outcomes, including greater client improvement. This stands in stark contrast to findings from efficacy trials that suggest using a limited number of practices and sticking with these throughout treatment is most effective. It seems possible that these patterns differ across these two setting and might indicate that the mechanisms for therapeutic gain differ.
Our general stance is to be contrarians within our own group of evidence-based scientists and practitioners. We hope and believe that our work will advance our scientific understanding in this important area and ultimately improve mental health services.