15, No. 2
Some Commonly Prescribed Evidence-Based Interventions
From “Choosing the Right Treatment: What Families Need to Know About Evidence-Based Practices” (NAMI, 2007).
Cognitive Behavioral Therapy (CBT). CBT teaches youth to notice, evaluate, and ultimately change their thinking, which in turn impacts their feelings and behavior. In CBT, youth examine and interrupt automatic negative thoughts that they may have that make them draw negative and inappropriate conclusions about themselves and others. For example, if a youth gets bumped in the hallway, his automatic thought may be that someone did it on purpose. So he pushes back and ends up in a fight. CBT helps youth question and eventually stop automatic negative thoughts, and to improve coping and problem-solving skills. Family involvement in CBT includes parents reinforcing more sensible and positive thoughts and helping the child practice this new way of thinking outside of the clinician’s office.
TF-CBT helps children aged 4-18 and their parents overcome the negative effect of traumatic life experiences. Comprised of 12-16 one-hour sessions, it teaches children skills such as emotion and stress management, personal safety, coping with trauma reminders, and linking trauma-related thoughts, feelings, and behaviors. TF-CBT teaches parents to encourage children’s use of these skills, and teaches parenting skills. It is associated with sustained improvement in PTSD symptoms, depression, anxiety, behavior problems, and sexualized behaviors, as well as reduced feelings of shame and mistrust. TF-CBT has been found to be highly effective with youth in foster care, reducing trauma symptoms and placement interruptions (i.e., running away, arrests). Parental involvement in TF-CBT increases the positive effects. Thus, involvement of both foster and birth parents in TF-CBT is highly desirable, particularly when reunification is a goal. TF-CBT allows for substantial flexibility to facilitate birth parent participation.
Source: FFTA, 2008
Exposure Therapy. Exposure therapy teaches children and adolescents how to manage fears and worries to reduce their distress. The therapist gently, persistently, and gradually exposes the child to the situation that causes the extreme fear, while talking with the child about his or her fear and anxiety and providing therapeutic support. The child is introduced to replacement strategies to reduce anxiety (such as deep breathing, exercise, and talking), with the expectation that the fear will be reduced and ultimately eliminated.
Interpersonal Therapy (IPT). Designed for adolescents with depression, IPT examines how relationships and transitions affect a youth’s thinking and feeling. IPT focuses on the adolescent and helps them manage major changes in their lives, such as divorce and significant loss. Unfortunately, few providers are trained in IPT, so it may be challenging for families to access IPT treatment for their child.
Behavior Therapy. Behavior therapy helps a child or adolescent change negative behaviors and improve behaviors in school, at home, and with peers through a reward and consequence system. Goals are set for the child and small rewards are earned for positive behavior. Children may also lose privileges or be put in time-out for a brief period for failing to meet expectations, although the primary therapeutic focus is on reinforcing positive behavior through valued rewards and earned privileges. Families play an essential role in developing goals for their child and in administering the reward and consequence system.
Intensive Home and Community-Based Interventions
Wrap-around Services. Wrap-around is a philosophy of care that includes a planning process with the child and family that results in a unique set of community services and natural supports individualized for that child and family to achieve a positive set of outcomes. The family meets with a wrap-around facilitator and together they explore the family’s strengths, needs, culture, goals, past successes, and expectations. Families add members to the team and team members take responsibility for action steps to benefit the family. Once outcomes are accomplished and the team nears its goals, the transition is negotiated with the team. The family and team decide how the family will continue to get support after they have formally transitioned out of wrap-around. The team also establishes how the family will return to wrap-around, if necessary.
Multisystemic Therapy (MST). MST is short-term and intensive home-based therapy. MST therapists have small case loads (from four to six families) designed to meet the immediate needs of families. The MST team is available 24 hours a day, seven days a week. MST therapists work to empower families by identifying family strengths and natural supports. MST therapists work with the family to address barriers such as: high stress, parental substance use, poor relationships within the family, and more. The MST team uses evidence-based therapies in working with youth and their families, including behavior therapy, CBT, and others. Families take the lead in setting treatment goals and MST therapists help them to achieve those goals. Research has shown that MST is an effective alternative to incarceration for youth involved in the juvenile justice system.
Treatment Foster Care (TFC). TFC is a placement outside of the family home for youth with serious mental health treatment needs. Trained treatment parents work with youth in the treatment home to provide a structured and therapeutic environment while enabling the youth to live in a family setting. Youths are placed in TFC because of their serious treatment needs and difficult behaviors, to allow them to receive a more intensive level of treatment in the community with ongoing contact with biological families, when feasible. Treatment foster parents work closely with the TFC agency, the child’s treatment team, and other professionals, which may include a teacher, therapist, and psychiatrist, to help develop and implement a treatment plan.
References for this and other articles in this issue