Brief Interventions Can Improve Children's Behavioral Health Services

In Connecticut, nearly half (49%) of children who begin outpatient treatment leave before their clinician feels they are ready. Thirteen percent drop out of treatment within the first three sessions, with children of color more likely to leave treatment during this time.

This mismatch between the traditional approach to therapy and family perceptions of treatment needs is also reflected in the national data. Outpatient service protocols on average call for 16 sessions, yet nationally, children only attend an average of four. Lengthy treatment protocols are not only at odds with the reality of shorter treatment duration for many children; it is not clear that more treatment sessions are beneficial.

“Lengthy treatment protocols are not only at odds with the reality of shorter treatment duration for many children; it is not clear that more treatment sessions are beneficial.”

 A meta-analysis of 447 studies across 50 years found the number of treatment sessions was not associated with outcomes; further, the longer children were in treatment, the less improvement they made.” A stepped-care approach that offers flexibility and matches families to the appropriate service intensity helps families and providers. Some children will need and benefit from longer-term treatment; others will be better served by having shorter or less intensive options, which could reduce wait lists and help mitigate workforce shortages.

One factor that is consistently associated with improved outcomes is the use of evidence-based treatments (EBTs). In Connecticut, clinicians report that 54% of children served in outpatient clinics receive at least part of an EBT protocol. The EBTs in Connecticut’s outpatient system, such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT); Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH-ADTC); and Cognitive Behavioral Therapy (CBT), offer clear goals, a structured approach, and measures of progress. Compared to treatment as usual (TAU), EBTs provide clear parameters to ensure treatment time is used effectively.

There is a growing body of evidence demonstrating the effectiveness of brief treatments for children. The briefest of these are single-session interventions (SSIs). SSIs are “specific, structured programs that intentionally involve just one visit or encounter with a clinic, provider, or program.

Rather than assuming it will take months to make progress, these interventions are designed to make improvements in as little as an hour. A meta-analysis of 50 SSIs, including both clinician-administered and online self-administered interventions, found modest improvements in child outcomes in a single session, with some effects lasting for months.

“As the need for behavioral health services for children is on the rise nationally and in Connecticut, a flexible array of treatment options that can be matched to family needs and preferences is ideal for both families and providers.”

As the need for behavioral health services for children is on the rise nationally and in Connecticut, a flexible array of treatment options that can be matched to family needs and preferences is ideal for both families and providers. We make the following recommendations to incorporate brief interventions into Connecticut’s service array:

·         Expand the service array by training clinicians in brief and single-session interventions that meet the needs of the outpatient population. SSC is one promising model to consider.

·         Identify and address regulations and billing requirements for use of brief interventions in outpatient settings, as well as task shifting to support non-clinical staff who may be able to deliver SSIs and support other aspects of care.

·         Establish a stepped-care approach to outpatient services with protocols to match families to the most appropriate level of services, including brief/single-session interventions. This process should use standardized assessments, measurement-based care, and family preferences to make initial recommendations as well as ongoing treatment planning and changes to services. 

·         Once models are available, increase public awareness and advertising about brief and single-session interventions as a treatment option.

·         Evaluate the use of brief interventions and their effectiveness and potential cost savings. Use data to understand for which populations (e.g., ages, diagnoses) brief interventions are most effective. Use data to inform improvements to stepped care approaches and algorithms.

·         Expand the behavioral health workforce to include professionals who are not mental health clinicians, and explore stepped-care approaches that involve these individuals in the delivery of appropriate brief interventions. Consider piloting such an approach with non-clinical staff delivering the SSC model.

This is an excerpt of an Issue Brief published by the Child Health and Development Institute.  To read the entire brief, Making the Most of the Moment, go here.  It was written by Kellie Randall, Jason Lang, Heather Solak, and Jessica Schleider (Stony Brook University).  For more information, visit www.chdi.org.