A therapist survey of evidence-based practices in publicly funded youth mental health

Abstract

Publicly funded services, such as Medicaid, account for close to half of all youth mental health (MH) services in the U.S. (Buck, 2003; Mark et al., 2007; Pires, 2013). Outcome studies of treatment as usual (TAU), particularly within publicly funded youth MH service systems, have demonstrated variable effects, with average effect sizes close to zero (Bickman et al., 2000; Garland, Bickman & Chorpita, 2010; Zima et al., 2005; Weisz et al., 2017). This contrasts with the medium to large average effect sizes in controlled clinical trials for evidence-based treatments (EBTs) for youth MH problems (Weisz, Jensen-Doss & Hawley, 2006). One potential reason for this discrepancy may be that therapists within TAU contexts are not implementing EBTs. To date, few studies have examined use of specific treatment strategies, whether evidence-based or not, in these settings. In a statewide survey of therapists providing youth MH care funded by Medicaid and the State Child Health Insurance Program (S-CHIP), 780 therapists reported on their use of treatment strategies with a recent, representative youth case presenting with primary anxiety, depression, or conduct problems. Therapists reported using a wide range of treatment strategies, but showed a preference for implementing transdiagnostic EBT strategies over both (a) EBT strategies specific to a particular patient presentation (e.g., exposure for anxiety) and (b) strategies without a strong evidence base (e.g., pleasant activity scheduling for conduct problems). We examined multiple therapist (e.g., theoretical orientation, treatment manual use, discipline), organizational setting, and client level (e.g., age) predictors of EBT use. Provider treatment manual use, perceived efficacy in treatment, learning theory orientation, private practice setting, younger client age, and longer time since degree completion predicted more frequent implementation of EBT strategies. We discuss how such features may be targeted in future training and implementation efforts in order to increase EBT use within publicly funded youth MH service contexts.