New Research Looks to Fill Gaps in Youth Mental Health Treatment

A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that the effectiveness of youth mental health services can be improved by providing clinicians with frequent youth and family feedback and coaching leaders to support clinicians’ effective use of the feedback. Improving the use of treatment feedback is a top priority for policymakers, funders, researchers, clinicians and family advocates, because use of feedback can significantly reduce the high rates of treatment failure (50%) observed in youth mental health services.

Dozens of clinical trials have shown that mental health services are more effective when clinicians receive frequent feedback (e.g., weekly) on how patients are responding to treatment using standardized symptom rating scales. That said, very few clinicians use treatment feedback measures with youth, and even when use of measures is mandated by policymakers, clinicians often fail to view the feedback or use it. To solve this research-to-practice gap, faculty members from Boise State University, the University of California San Diego, the University of Pennsylvania and the University of Central Florida partnered to test a strategy that trains leaders of mental health clinics to create organizational climates that support the use of treatment feedback.

The research team received funding from the U.S. National Institute of Mental Health to test an implementation strategy that targeted clinic leaders to improve the use of treatment feedback and the outcomes of mental health services for youth. The investigators enrolled 21 community mental health clinics delivering psychotherapy to youth in Idaho, Oregon and Nevada. Clinicians who worked with youth at these clinics were provided with training and technical assistance to use an empirically-supported, web-based treatment feedback system. Half the clinics were randomly assigned to a strategy that provided their leaders with specialized training and coaching; the other half served as a control group.

Results from the trial indicated the strategy improved clinicians’ administration of feedback measures by 3.5-fold, improved clinician viewing of measures by 6.9-fold and improved the percentage of youth who meaningfully improved in their mental health symptoms by almost 2-fold.

“Developing strategies that enable mental health clinicians and leaders to effectively use research-based tools like treatment feedback is a defining challenge of our time,” said Dr. Nate Williams, associate professor of social work at Boise State University and lead of the study. “The results of this trial are exciting because they show that we can make real, observable improvements in the quality and outcomes of mental health care for youth.”

Notes for editors

The article is "Randomized Trial of an Organizational Implementation Strategy to Improve Measurement-Based Care Fidelity and Youth Outcomes in Community Mental Health," by Nathaniel J. Williams, PhD, Steven C. Marcus, PhD, Mark G. Ehrhart, PhD, Marisa Sklar, PhD, Susan M. Esp, PhD, Kristine Carandang, PhD, OTR/L, Nallely Vega, MSW, Alexandra E. Gomes, MSW, Lauren Brookman-Frazee, PhD, Gregory A. Aarons, PhD (https://doi.org/10.1016/j.jaac.2023.11.010). It appears in Journal of the American Academy of Child & Adolescent Psychiatry, volume 63, issue 10(October 2024), published by Elsevier.

Copies of this paper are available to credentialed journalists upon request; [email protected]

About JAACAP

Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.

The Journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.

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