Flexibility within Fidelity: Implementing empirically-based practices with children and adolescents

1. Flexibility within Fidelity:Implementing empirically-based practices with children and adolescents Philip C. Kendall, Ph.D., ABPP Laura H. Carnell Professor of Psychology Temple University APA, August, 2006

2. Empirically-Based and Empirically-Supported Treatments • What are empirically-based treatments? • What are empirically-supported treatments? • What are the criteria that were applied when selecting empirically-supported treatments? • What would we do/use if we rejected these criteria? Keep this question in mind.

3. Empirically-Based Treatments • For depressed youth • For ADHD • For conduct problem youth • For anxiety disordered youth

4. Empirically-Supported Treatments • For depressed youth • For ADHD • For conduct problem youth • For anger management • For anxiety disorders in youth

5. Sources: Journals and chapters • Journal of Consulting and Clinical Psychology, 66, 1998. Special Issue (February). • Journal of Clinical Child Psychology, 27, 1998 Special Issue. • Ollendick T., King, N., & Chorpita (2006). Empirically supported treatments for children and adolescents. In P. C. Kendall (Ed.) Child and adolescent therapy (3rd ed.). New York: Guilford Press.

6. Sources: Books • Kazdin, A. & Weisz, J. (Eds.) (2003). Evidence-based psychotherapies for children and adolescents. New York: Guilford Press. • Hibbs, E.D., & Jensen, P S. (Eds.) (2005). Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice (2nd ed.). Washington DC: APA.

7. What is treatment fidelity? • The treatment as written was the treatment that was provided • Features of the target treatment (as written and provided) did not bleed over into a comparison treatment • Treatment fidelity in not treatment quality: Treatment quality refers to an expert judgment

8. Implementing EST’s • Empirically-supported treatments typically incorporate empirically-based strategies and have available (and follow) therapist manuals. • What is it like implementing a manual for treatment?

9. CRITICS Steadfast and linear Cookbooks Prevent creativity Lack “individuality” Do not match real client presentations ADVOCATES Manuals require clinical skill Facilitate training Necessary for evaluation CAN be done flexibly Manual-based treatments:What do the critics and advocates say?

10. Flexibility within Fidelity:The case of treating anxious youth • 16 sessions: psychoeducation and exposure tasks • www.WorkbookPublishing.com • www.childanxiety.org • The FEAR plan • Exposure tasks • Rewards • Parental participation • Celebrating success (e.g. certificate, commercial)

11. Easing transportability:Studying the process of an EST • Child involvement (Chu & Kendall, 2004; Braswell, Kendall, Braith, Carey, & Vye, 1985) • Therapist “relationship building” strategies (Creed & Kendall, 2005) • Therapist flexibility (Kendall & Chu, 2000) • Timing and interaction of these processes?(Kendall, Hudson, Gosch, & Chu, in progress)

12. Easing transportability:Flexibility within fidelity • Highly creative, not rule bound, within a proscribed approach • Tailored to the individual, within the target goal • Sensitive to child/parent factors • Capable of being evaluated scientifically

13. Easing transportability:Next steps? • We now face the challenge of providing evidence-based explanations for change. • Examine mediators (Treadwell & Kendall, 1996; Kendall & Treadwell, 2005) • Let’s face it, Kiesler (1966; 1971) was at least partially right. There’s no one treatment that is effective for everyone. • We need to continue to address the question “What therapeutic approaches are effective with which types of clients in producing which kinds of change?” and to disseminate the findings. • Goin' fishing and showing slides

14. Empirically-based and empirically-supported treatments: Flexibility within treatment fidelity What else would we do?