Person: Weisz, John
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Weisz
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Weisz, John
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Publication What Five Decades of Research Tells Us About the Effects of Youth Psychological Therapy: A Multilevel Meta-Analysis and Implications for Science and Practice.(American Psychological Association (APA), 2017-02) Weisz, John; Kuppens, Sofie; Ng, Mei Yi; Eckshtain, Dikla; Ugueto, Ana; Vaughn-Coaxum, Rachel; Jensen-Doss, Amanda; Hawley, Kristin; Marchette, Lauren; Chu, Brian; Weersing, Robin; Fordwood, SamanthaAcross 5 decades, hundreds of randomized trials have tested psychological therapies for youth internalizing (anxiety, depression) and externalizing (misconduct, attention deficit and hyperactivity disorder) disorders and problems. Since the last broad-based youth meta-analysis in 1995, the number of trials has almost tripled and data-analytic methods have been refined. We applied these methods to the expanded study pool (447 studies; 30,431 youths), synthesizing 50 years of findings and identifying implications for research and practice. We assessed overall effect size (ES) and moderator effects using multilevel modeling to address ES dependency that is common, but typically not modeled, in meta-analyses. Mean posttreatment ES was 0.46; the probability that a youth in the treatment condition would fare better than a youth in the control condition was 63%. Effects varied according to multiple moderators, including the problem targeted in treatment: Mean ES at posttreatment was strongest for anxiety (0.61), weakest for depression (0.29), and nonsignificant for multiproblem treatment (0.15). ESs differed across control conditions, with “usual care” emerging as a potent comparison condition, and across informants, highlighting the need to obtain and integrate multiple perspectives on outcome. Effects of therapy type varied by informant; only youth-focused behavioral therapies (including cognitive-behavioral therapy) showed similar and robust effects across youth, parent, and teacher reports. Effects did not differ for Caucasian versus minority samples, but more diverse samples are needed. The findings underscore the benefits of psychological treatments as well as the need for improved therapies and more representative, informative, and rigorous intervention science.Publication The Global Therapist Competence Scale for Youth Psychosocial Treatment: Development and Initial Validation(Wiley, 2017-09-25) Brown, Ruth; Southam-Gerow, Michael; McLeod, Bryce; Wheat, Emily; Tully, Carrie; Reise, Steven; Kendall, Philip; Weisz, JohnOBJECTIVE: We describe the development and initial psychometric properties of the observer-rated Global Therapist Competence Scale for Youth Psychosocial Treatment (G-COMP) in the context of cognitive-behavioral treatment (CBT) for youth anxiety disorders. METHOD: Independent coders rated 744 sessions from a sample of 68 youth (mean age = 10.56 years) using the G-COMP and the instruments of alliance, involvement, CBT adherence, CBT competence. RESULTS: Inter-rater reliability coefficients, ICC(2,2), were greater than .60 for the 5 G-COMP domain scores. G-COMP scores yielded small to medium correlations with instruments of alliance (rs = .17-.44) and youth involvement in treatment (rs = .08-.53), and medium to large correlations with instruments of CBT competence and adherence (rs = .26-.63). Therapists in the research setting were rated higher compared to newly trained therapists in community clinics. CONCLUSION:Preliminary reliability and validity of the G-COMP are promising, but future research is needed with non-CBT samples.Publication Modular Approach to Therapy for Anxiety, Depression, Trauma, or Conduct Problems in outpatient child and adolescent mental health services in New Zealand: study protocol for a randomized controlled trial(BioMed Central, 2015) Lucassen, Mathijs F. G.; Stasiak, Karolina; Crengle, Sue; Weisz, John; Frampton, Christopher M. A.; Bearman, Sarah Kate; Ugueto, Ana M.; Herren, Jennifer; Cribb-Su’a, Ainsleigh; Faleafa, Monique; Kingi-’Ulu’ave, Denise; Loy, Jik; Scott, Rebecca M.; Hartdegen, Morgyn; Merry, Sally N.Background: Mental health disorders are common and disabling for young people because of the potential to disrupt key developmental tasks. Implementation of evidence-based psychosocial therapies in New Zealand is limited, owing to the inaccessibility, length, and cost of training in these therapies. Furthermore, most therapies address one problem area at a time, although comorbidity and changing clinical needs commonly occur in practice. A more flexible approach is needed. The Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH-ADTC) is designed to overcome these challenges; it provides a range of treatment modules addressing different problems, within a single training program. A clinical trial of MATCH-ADTC in the USA showed that MATCH-ADTC outperformed usual care and standard evidence-based treatment on several clinical measures. We aim to replicate these findings and evaluate the impact of providing training and supervision in MATCH-ADTC to: (1) improve clinical outcomes for youth attending mental health services; (2) increase the amount of evidence-based therapy content; (3) increase the efficiency of service delivery. Methods: This is an assessor-blinded multi-site effectiveness randomized controlled trial. Randomization occurs at two levels: (1) clinicians (≥60) are randomized to intervention or usual care; (2) youth participants (7–14 years old) accepted for treatment in child and adolescent mental health services (with a primary disorder that includes anxiety, depression, trauma-related symptoms, or disruptive behavior) are randomly allocated to receive MATCH-ADTC or usual care. Youth participants are recruited from ‘mainstream’, Māori-specific, and Pacific-specific child and adolescent mental health services. We originally planned to recruit 400 youth participants, but this has been revised to 200 participants. Centralized computer randomization ensures allocation concealment. The primary outcome measures are: (i) the difference in trajectory of change of clinical severity between groups (using the parent-rated Brief Problem Monitor); (ii) clinicians’ use of evidence-based treatment procedures during therapy sessions; (iii) total time spent by clinicians delivering therapy. Discussion If MATCH-ADTC demonstrates effectiveness it could offer a practical efficient method to increase access to evidence-based therapies, and improve outcomes for youth attending secondary care services. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12614000297628.Publication Odd Couple? Reenvisioning the Relation Between Science and Practice in the Dissemination-Implementation Era(SAGE Publications, 2013) Weisz, John; Ng, M. Y.; Bearman, S. K.Decades of clinical psychological science have produced empirically supported treatments that are now undergoing dissemination and implementation (DI) but with little guidance from a science that is just taking shape. Charting a future for DI science (DIS) and DI practice (DIP), and their complex relationship, will be complicated by significant challenges—the implementation cliff (intervention benefit drops when tested practices are scaled up), low relevance of most clinical research to actual practice, and differing timetables and goals for DIP versus DIS. To address the challenges, and prepare the next generation of clinical psychological scientists, we propose the following: making intervention research look more like practice, solving the “too many empirically supported treatments” problem, addressing mismatches between interventions and their users (e.g., clients, therapists), broadening the array of intervention delivery systems, sharpening outcome monitoring and feedback, incentivizing high-risk/high-gain innovations, designing new professional tracks, and synchronizing and linking the often-insular practice and science of DI.Publication The role of setting versus treatment type in alliance within youth therapy.(American Psychological Association (APA), 2016) McLeod, Bryce D.; Jensen-Doss, Amanda; Tully, Carrie B.; Southam-Gerow, Michael A.; Weisz, John; Kendall, Philip C.Objective: Does the strength of the youth–therapist alliance differ across treatment settings or treatment type? We examined these questions in the context of youth therapy. Method: Eighty-nine youths (M age = 10.56, SD = 1.99; 63.70% Caucasian; 52.80% male) diagnosed with an anxiety disorder received (a) manual-based individual cognitive–behavioral therapy (ICBT) in a research setting, (b) manual-based ICBT in practice settings, or (c) nonmanualized usual care (UC) in practice settings. Coders, using the Therapy Process Observational Coding System–Alliance scale, rated 865 sessions. Youth completed the Therapeutic Alliance Scale for Children at posttreatment. Results: Youth who received ICBT in a research setting had significantly higher observer-rated alliance than youth who received either therapy delivered in practice settings. In practice settings, youth who received ICBT had significantly stronger observer-rated alliance early in treatment than youth in UC, but this difference was not observed at the end of treatment. Similarly, youth-report alliance at posttreatment was significantly higher in ICBT in the research setting, and there was no difference between ICBT and UC delivered in practice settings. Alliance differences largely held when controlling for youth characteristics; however, differences early in treatment between the ICBT groups were no longer statistically significant when controlling for anxiety severity or primary anxiety diagnosis. Conclusions: Our findings suggest that (a) the alliance may be stronger in research settings, and (b) treatment manuals do not undermine alliance. Future research is required to help pinpoint whether other youth, therapist, or setting factors contribute to the lower alliance seen in practice settings. (PsycINFO Database Record (c) 2016 APA, all rights reserved)Publication Implicit Theories Relate to Youth Psychopathology, But How? A Longitudinal Test of Two Predictive Models(Springer Nature, 2015) Schleider, Jessica; Weisz, JohnResearch shows relations between entity theories—i.e., beliefs that traits and abilities are unchangeable—and youth psychopathology. A common interpretation has been that entity theories lead to psychopathology, but another possibility is that psychopathology predicts entity theories. The two models carry different implications for developmental psychopathology and intervention design. We tested each model’s plausibility, examining longitudinal associations between entity theories of thoughts, feelings, and behavior and psychopathology in early adolescents across one school year (N = 59, 52 % female, ages 11–14, 0 % attrition). Baseline entity theories did not predict increases in psychopathology; instead, baseline psychopathology predicted increased entity theories over time. When symptom clusters were assessed individually, greater youth internalizing (but not externalizing) problems predicted subsequent increases in entity theories. Findings suggest that the commonly proposed predictive model may not be the only one warranting attention. They suggest that youth psychopathology may contribute to the development of certain kinds of entity theories.Publication Annual Research Review: Building a science of personalized intervention for youth mental health(Wiley-Blackwell, 2015) Ng, Mei Yi; Weisz, JohnBackground Within the past decade, health care service and research priorities have shifted from evidence-based medicine to personalized medicine. In mental health care, a similar shift to personalized intervention may boost the effectiveness and clinical utility of empirically supported therapies (ESTs). The emerging science of personalized intervention will need to encompass evidence-based methods for determining which problems to target and in which order, selecting treatments and deciding whether and how to combine them, and informing ongoing clinical decision-making through monitoring of treatment response throughout episodes of care. We review efforts to develop these methods, drawing primarily from psychotherapy research with youths. Then we propose strategies for building a science of personalized intervention in youth mental health. Findings The growing evidence base for personalizing interventions includes research on therapies adapted for specific subgroups; treatments targeting youths’ environments; modular therapies; sequential, multiple assignment, randomized trials; measurement feedback systems; meta-analyses comparing treatments for specific patient characteristics; data-mining decision trees; and individualized metrics. Conclusion The science of personalized intervention presents questions that can be addressed in several ways. First, to evaluate and organize personalized interventions, we propose modifying the system used to evaluate and organize ESTs. Second, to help personalizing research keep pace with practice needs, we propose exploiting existing randomized trial data to inform personalizing approaches, prioritizing the personalizing approaches likely to have the greatest impact, conducting more idiographic research, and studying tailoring strategies in usual care. Third, to encourage clinicians’ use of personalized intervention research to inform their practice, we propose expanding outlets for research summaries and case studies, developing heuristic frameworks that incorporate personalizing approaches into practice, and integrating personalizing approaches into service delivery systems. Finally, to build a richer understanding of how and why treatments work for particular individuals, we propose accelerating research to identify mediators within and across RCTs, to isolate mechanisms of change, and to inform the shift from diagnoses to psychopathological processes. This ambitious agenda for personalized intervention science, although challenging, could markedly alter the nature of mental health care and the benefit provided to youths and families.Publication Improving practice in community-based settings: a randomized trial of supervision – study protocol(BioMed Central, 2013) Dorsey, Shannon; Pullmann, Michael D; Deblinger, Esther; Berliner, Lucy; Kerns, Suzanne E; Thompson, Kelly; Unützer, Jürgen; Weisz, John; Garland, Ann FBackground: Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes ‘gold standard’ supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes. Methods/Design The study has two phases. We will conduct an initial descriptive study (Phase I) of supervision practices within public mental health in Washington State followed by a randomized controlled trial of gold standard supervision strategies (Phase II), with randomization at the clinician level (i.e., supervisors provide both conditions). Study participants will be 35 supervisors and 130 clinicians in community mental health centers. We will enroll one child per clinician in Phase I (N = 130) and three children per clinician in Phase II (N = 390). We use a multi-level mixed within- and between-subjects longitudinal design. Audio recordings of supervision and therapy sessions will be collected and coded throughout both phases. Child outcome data will be collected at the beginning of treatment and at three and six months into treatment. Discussion This study will provide insight into how supervisors can optimally support clinicians delivering evidence-based treatments. Phase I will provide descriptive information, currently unavailable in the literature, about commonly used supervision strategies in community mental health. The Phase II randomized controlled trial of gold standard supervision strategies is, to our knowledge, the first experimental study of gold standard supervision strategies in community mental health and will yield needed information about how to leverage supervision to improve clinician fidelity and client outcomes. Trial registration ClinicalTrials.gov NCT01800266Publication The Youth Self Report: Applicability and Validity Across Younger and Older Youths(Informa UK Limited, 2011) Ebesutani, Chad; Bernstein, Adam; Martinez, Jonathan I.; Chorpita, Bruce F.; Weisz, JohnThe Youth Self Report (YSR) is a widely used measure of youth emotional and behavioral problems. Although the YSR was designed for youths ages 11 to 18, no studies have systematically evaluated whether youths younger than age 11 can make valid reports on this measure. This study thus examined the reliability and validity of the YSR scales scores for younger (ages 7–10; n = 184) and older (ages 11–14; n = 147) youths. Results demonstrated that younger youths were able to provide reliable reports on the YSR broad band (Internalizing, Externalizing) scales, though less so on the narrow band scales. Across all scales, the externalizing scales performed more favorably than the internalizing scales among both younger and older youth. Younger youths’ DSM-oriented scales corresponded significantly with DSM diagnoses.Publication Do treatment manuals undermine youth–therapist alliance in community clinical practice?(American Psychological Association (APA), 2011) Langer, David A.; McLeod, Bryce D.; Weisz, JohnObjective: Some critics of treatment manuals have argued that their use may undermine the quality of the client–therapist alliance. This notion was tested in the context of youth psychotherapy delivered by therapists in community clinics. Method: Seventy-six clinically referred youths (57% female, age 8–15 years, 34% Caucasian) were randomly assigned to receive nonmanualized usual care or manual-guided treatment to address anxiety or depressive disorders. Treatment was provided in community clinics by clinic therapists randomly assigned to treatment condition. Youth–therapist alliance was measured with the Therapy Process Observational Coding System—Alliance (TPOCS–A) scale at 4 points throughout treatment and with the youth report Therapeutic Alliance Scale for Children (TASC) at the end of treatment. Results: Youths who received manual-guided treatment had significantly higher observer-rated alliance than usual care youths early in treatment; the 2 groups converged over time, and mean observer-rated alliance did not differ by condition. Similarly, the manual-guided and usual care groups did not differ on youth report of alliance. Conclusions: Our findings did not support the contention that using manuals to guide treatment harms the youth–therapist alliance. In fact, use of manuals was related to a stronger alliance in the early phase of treatment.