The Clinic Treatment Project (CTP)

Judge Baker Children's Center

Status: Completed

Conditions: Depression; Anxiety; Problem Behavior

Treatments: Behavioral: evidence-based treatment; Behavioral: modular evidence-based treatment; Behavioral: psychotherapy

Study type: Interventional

Funder types: Other

Identifiers

NCT01178554

83423-0

Details and patient eligibility

About

The Clinic Treatment Project tested two alternative methods of delivering evidence-based practices within public community-based mental health clinics, using training and supervision procedures designed for the settings and users.

Full description

The Clinic Treatment Project focused on ethnically diverse youths aged 7-13 who were referred to community-based mental health clinics for problems involving disruptive behaviors, depression, anxiety, and any combination of these. Using a randomized block design, therapists were randomly assigned to deliver usual treatment procedures (usual care, or UC) in their clinics or evidence-based practices deployed in two forms: (a) standard manual treatment (SMT), using full treatment manuals, one at a time, exactly as they have been tested in clinical trials, and (b) modular manual treatment (MMT) in which therapists learn the component practices of the standard manuals but individualize the use of the components for each child using a guiding clinical algorithm. Unlike the SMT approach, the MMT approach allows the duration and sequencing of techniques to be individualized in an effort to fit the child's needs and allows the clinician to draw techniques from outside the target disorder domain when needed (e.g., to address noncompliance during the course of treating depression). Both SMT and MMT were supported by training and supervision procedures designed to fit providers and their clinic contexts. Assessments were carried out at pre-treatment, at post-treatment, and at 3-, 6-, 9-, 12-, 18-, and 24-month follow-ups. Assessments carried out at pre-treatment included(a) individual youth problems and disorders; (b) individual youth functioning at home and school; and (c) clinic staff beliefs and attitudes toward their work and workplace. Assessments carried out at post-treatment and follow-up only included measures of (a) youth, parent, and therapist satisfaction with treatment; (b) youth, parent and therapist views on the quality of the therapeutic relationship; and (c) treatment costs. Assessments carried out at follow-up only included (a) parent reports of any mental health service use following project treatment, and (b) therapist reports on the extent to which the treatment procedures they used in the project are continued after project termination. Analyses will address critical questions about deployment of evidence-based youth practices to clinical care settings.

Enrollment: 203 patients

Sex: All

Ages: 7 to 13 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 7 - 13 year olds and their parents
• seeking services at community mental health clinics
• primary problem or disorder related to anxiety, depression, or conduct problems

Exclusion criteria

• Child is younger than 7 years, 9 months or older than 13 on the day of the phone screen.
• Child has attempted suicide within the past year.
• Schizophrenic spectrum diagnosis (including MDD w/ psychotic features)
• Autism or another Pervasive Developmental Disorder (e.g., PDD NOS, Asperger's Disorder, Child Disintegrative Disorder, Rett's Disorder).
• Anorexia Nervosa
• Bulimia Nervosa
• Mental Retardation
• No relevant T-scores validate target disorders.
• ADHD identified as primary reason for seeking treatment at phone screen
• Child's sibling already included
• Child's medication has not been regulated for one month or longer

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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203 participants in 3 patient groups

Usual Care Treatment

Active Comparator group

Description:

Usual Care therapists could use any treatment procedures they used regularly in their clinical practice.

Treatment:

Behavioral: psychotherapy

Standard Manual Treatment (SMT)

Experimental group

Description:

Evidence-based treatment manuals were used for anxiety (Coping Cat Manual; Kendall, 1994; Kendall et al., 1994 ), depression (Primary and Secondary Control Enhancement Training; Weisz et al., 1997, 1998), and conduct problems (Defiant Children Manual; Barkley, 1997).

Treatment:

Behavioral: evidence-based treatment

Modular Maual Treatment (MMT)

Experimental group

Description:

Therapists used a modular manual (Modular Approach to Therapy for Children with Anxiety, Depression, or Conduct Problems; Chorpita \& Weisz, 2004) to help children with primary problems of anxiety, depression, and conduct.

Treatment:

Behavioral: modular evidence-based treatment