Best and evidence-based practices in mental health are the types of treatment and services for children and families that are known to work the best. It is sometimes frustrating for parents to learn that unlike other forms of medicine, mental health treatment does not always follow specific guidelines or have research that shows that it works. However, the mental health field has come a long way in the past decade and we are learning more and more about what types of treatment work best to address a range of mental health issues and concerns.
Best practices may be new or emerging practices that have gotten the attention of consumers, providers and researchers as being effective or promising treatments for certain disorders. There may be some research to show that these treatments are effective, but clinicians use these treatments primarily because they are accepted as the best available treatment for certain concerns. Some best practices eventually become “evidence-based practices” because they have specific guidelines and are shown through numerous research studies to be effective for relieving targeted symptoms and improving your child’s day-to-day functioning. Evidence-based treatments meet a high standard for quality and effectiveness and clinicians receive specific training to deliver them to children and families.
For many, but not all disorders, best practices and evidence-based practices have been identified. It is important to ask your provider if there are best practices or evidence based practices available to treat your child’s difficulty, and if the provider has been trained to use these approaches. The Federal Government has attempted to list and describe best and evidence-based practices and you can find this information in the Evidence-Based Practice Resource Center website created by the Substance Abuse and Mental Health Services Administration (SAMHSA).
What are evidence-based practices?
Evidence-based Practices (EBPs) are systematic clinical intervention programs that are integrative in nature (practice, research, theory) and use systematic clinical protocols or “clinical maps” to guide practice. Typically, EBPs are manual driven (yet flexible), use continuous assessment procedures, and focus on model adherence and treatment fidelity. In addition, EBPs should be clinically and culturally responsive and individualized to the unique needs of the child and family. EBPs should guide practice with a high expectation of successfully targeting specific problems.
The Child Health and Development Institute (CHDI) has been instrumental in laying the groundwork that has led to the introduction of a range of evidence-based practices currently being provided to over 2,500 children annually in our behavioral health and juvenile justice systems in Connecticut. Most of these services are in-home treatments focused on children with high needs who are at risk for out-of-home placement. To learn more about CHDI’s work in Evidence-Based Practice, please click here.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Overview: TF-CBT is an outpatient intervention for children who are experiencing symptoms related to the exposure to a significant trauma such as physical or sexual abuse, loss of a loved one, interpersonal or community violence, natural disaster (such as tornado or flooding), chronic neglect, etc. TF-CBT is a time limited intervention, which usually lasts five to six months and involves outpatient sessions with both the child and caregiver. There has been strong evidence to support its efficacy in reducing symptoms of Post Traumatic Stress Disorder (PTSD) and depression in both children and their caregivers. The intervention is a manualized, phased intervention that helps the child develop and enhance their ability to cope with and regulate their responses to troubling memories, sensations and experiences. Over time through the course of treatment, the child develops a trauma narrative that helps them tell their story in a safe, supportive setting.
To find a TF-CBT provider in the State of Connecticut click on this link here.
TF-CBT Targets: Children ages 4-21 and their caregivers who have experienced a significant traumatic event and are experiencing chronic symptoms related to the exposure to the trauma.
Multisystemic Therapy (MST)
Overview: Multisystemic Therapy (MST) is an intensive family- and community-based treatment that addresses the multiple determinants of serious antisocial behavior in juvenile offenders. The multisystemic approach views individuals as being nested within a complex network of interconnected systems that encompass individual, family, and extra-familial (peer, school, neighborhood) factors. Intervention may be necessary in any one or a combination of these systems.
MST Targets: MST targets children and families who have severe behavioral health or substance abuse difficulties who are at high risk for out-of-home placement.
Multidimensional Family Therapy (MDFT) Program
Overview: Multidimensional Family Therapy is an intensive in-home program. MDFT focuses on several core areas of the teen’s life simultaneously – parents, schools, other family members and the community. The program also helps the family understand the connections between drug use, criminal behavior and mental health. During treatment, skills are learned which enhance positive peer relations: healthy self-esteem; connection to school and community activities; increased autonomy; emotional connection to family members. Parents and family members are also involved by learning and applying skills, which improve the relationship with their child or sibling; increase their knowledge of successful parenting practices; improve day-to-day and intimate communication.
MDFT Targets: Adolescents ages 11-18 with behavioral difficulties and serious substance abuse issues.
Functional Family Therapy (FFT)
Overview: The FFT clinical model identifies specific phases that organize the intervention in a coherent manner, thereby allowing clinicians to maintain focus in the context of considerable family and individual disruption. Each phase includes specific goals, assessment foci, specific techniques of intervention, and therapist skills necessary for success. Interventions focus on engagement/motivation, behavior change and generalization of new behaviors and skills.
FFT Targets: Children and youth ages 10-18, and their families, whose problems range from acting out to conduct disorder to alcohol/substance abuse.
Brief Strategic Family Therapy (BSFT)
Overview: Brief Strategic Family Therapy (BSFT) is a problem-focused, and practical approach to the elimination of substance abuse risk factors. It successfully reduces problem behaviors in children and adolescents and strengthens their families. BSFT provides families with tools to decrease individual and family risk factors through focused interventions that improve problematic family relations and skill building strategies that strengthen families.
BSFT fosters: parental leadership, appropriate parental involvement, mutual support among parenting figures, family communication, problem solving, clear rules and consequences, nurturing, and shared responsibility for family problems. In addition, the program provides specialized outreach strategies to bring families into therapy.
BSFT Targets: Children and adolescents ages 6 to 17 years with conduct problems, associations with anti-social peers and/or substance use, and problematic family relations.
Multidimensional Treatment Foster Care (MTFC)
Overview: The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement. Youth come to MTFC via referrals from the juvenile justice, foster care, and mental health systems.
MTFC treatment goals are accomplished by providing: Close supervision; fair and consistent limits; predictable consequences for rule breaking; a supportive relationship with at least one mentoring adult; and reduced exposure to peers with similar problems.
The intervention is multifaceted and occurs in multiple settings. The intervention components include: behavioral parent training and support for MTFC foster parents; family therapy for biological parents (or other aftercare resources); skills training for youth; supportive therapy for youth; school-based behavioral interventions and academic support; and psychiatric consultation and medication management, when needed.
MTFC Targets: Children in the foster care system ages 3-18 with multiple familial and behavioral concerns.
Intensive In-home Child and Adolescent Psychiatric Services (IICAPS)
Overview: IICAPS is a Yale University model created to meet the comprehensive needs of children with severe psychiatric disorders. The program makes use of a consistent treatment team to provide comprehensive assessments, case management, individual and family treatment, and crisis intervention. Intervention is informed by a synthesis of the medical model, development psychopathology, systems theory, and wraparound concepts.
IICAPS Targets: Children appropriate for IICAPS intervention may be returning home from psychiatric hospitalization, at risk for institutionalization or hospitalization, or unable to benefit from traditional outpatient treatment.
To learn more about the availability of these practices across Connecticut you should contact your local Department of Children and Families office or your local community-based mental health provider.
Child First, developed by Dr. Darcy Lowell, is an innovative evidence-based model which effectively decreases emotional and behavioral problems, developmental and learning problems, and abuse and neglect among very vulnerable young children (prenatal through age six years) and families. Child First directly addresses these risks through 1) comprehensive, integrated services and supports to the whole family, which decreases risk and increases the capacity of the parent to nurture and support the child, and 2) home-based, parent-child intervention, which builds the nurturing relationship, protects the developing brain and optimizes child emotional development, learning, and health. The effectiveness of the Child First model has been rigorously researched through a randomized clinical trial, demonstrating markedly improved outcomes in child mental health and language, parental stress and depression, protective service involvement, and access to community-based services.
Child First was established in the Bridgeport, Connecticut community over ten years ago. Currently, the model is being disseminated to six communities across the state of Connecticut through the support of a Robert Wood Johnson Foundation grant. To learn more about Child First please contact Darcy Lowell at (203) 384-3626.