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Articles   |    
Continued Use of Evidence-Based Treatments After a Randomized Controlled Effectiveness Trial: A Qualitative Study
Lawrence A. Palinkas, Ph.D.; John R. Weisz, Ph.D.; Bruce F. Chorpita, Ph.D.; Brooklyn Levine, M.S.W.; Ann F. Garland, Ph.D.; Kimberly E. Hoagwood, Ph.D.; John Landsverk, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.004682012
View Author and Article Information

Dr. Palinkas and Ms. Levine are with the School of Social Work, University of Southern California, 669 W. 34th St., Los Angeles, CA 90089 (e-mail: palinkas@usc.edu). Dr. Weisz is with the Department of Psychology, Harvard University, Cambridge, Massachusetts. Dr. Chorpita is with the Department of Psychology, University of California, Los Angeles. Dr. Garland is with the Department of School, Family, and Mental Health Professions, University of San Diego, San Diego. Dr. Hoagwood is with the Department of Psychiatry, New York University, New York City. Dr. Landsverk is with the Child and Adolescent Services Research Center, Rady Children’s Hospital, San Diego.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  This study examined the extent to which therapists who participated in a randomized controlled trial (RCT) of evidence-based treatments continued to use them with nonstudy clients after the trial as well as the types of treatment used and the reasons for their continued use.

Methods  Semistructured interviews and focus groups were conducted with 38 therapists, three clinical supervisors, and eight clinic directors three months after an RCT of evidence-based treatments for depression, anxiety, and conduct disorders among children and adolescents. The therapists had been assigned randomly to one of three conditions: modular (N=15), allowing flexible use and informed adaptations of treatment components; standard (N=13), using full treatment manuals; and usual care (N=10). Grounded-theory analytic methods were used to analyze interview transcripts.

Results  Twenty-six therapists (93%) assigned to the modular or standard condition used the treatments with nonstudy cases. Of those, 24 (92%) therapists, including all but two assigned to the standard condition, reported making some adaptation or modification, including using only some modules with all clients or all modules with some clients; changing the order or presentation of the modules to improve the flow or to work around more immediate issues; and using the modules with others, including youths with co-occurring disorders, youths who did not meet the age criteria, and adults.

Conclusions  The results provide insight into the likely sustainability of evidence-based treatments, help to explain why the outcomes of the RCT favored a modular approach, and highlight the strengths and limitations of use of evidence-based treatments.

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Anchor for Jump
Table 1Therapists’ reasons for continuing use of the evidence-based treatments after the randomized controlled triala
Table Footer Note

a For each evidence-based treatment, therapists were assigned to a modular condition, allowing flexible use and informed adaptations of treatment components, or a standard condition, using full treatment manuals.

Anchor for Jump
Table 2Therapists’ reasons for adapting or modifying the evidence-based treatments after the randomized controlled triala
Table Footer Note

a For each evidence-based treatment, therapists were assigned to a modular condition (N=15), allowing flexible use and informed adaptations of treatment components, or a standard condition (N=13), using full treatment manuals. Five therapists assigned to provide usual care were trained in the modular condition after the randomized controlled trial but had not used it.

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