Bridging the research-practice divide in youth psychotherapy: the deployment-focused model and transdiagnostic treatment

Abstract

Five decades of research have produced scores of empirically tested psychotherapies for youths who have mental health problems and disorders. These empirically supported treatments (ESTs), most of them focused on single disorders or single problem domains (e.g., depressive disorders), have shown substantial effects in randomized controlled efficacy trials. However, the ESTs do not fare as well when tested against usual clinical care with clinically referred youths treated in clinically representative conditions. One reason may be that referred youths and their clinical care contexts are sometimes more complex than the ESTs. For example, most youths referred for treatment have multiple problems and disorders, and their treatment needs shift over time. To address the differences between efficacy research conditions and clinical practice, we have proposed a deployment-focused model of treatment development and testing, recommending research that focuses on the kinds of individuals and intervention contexts for which the treatments are ultimately intended. Our work with colleagues consistent with the deployment-focused model has led to a transdiagnostic intervention approach, Child STEPs. STEPs uses an integrative modular treatment protocol derived from the psychotherapy evidence base, with treatment guided by frequent feedback to clinicians on youth treatment response. In a multisite randomized trial of this approach, applied to youths with anxiety, depression, and conduct problems, STEPs markedly outperformed usual clinical care on measures of clinical symptoms and diagnosis. The findings illustrate the potential of the deployment-focused approach to narrow the gap between clinical science and everyday clinical care.