Description
Mental health clinicians are under increasing pressure from health insurance companies, government agencies, and the general public to utilize evidence-based treatments (EBTs). EBTs, broadly defined, are psychotherapeutic techniques and protocols that have been submitted for empirical evaluation and demonstrated to be effective in reducing behavioral and/or emotional problems (Kazdin, 2008). Research indicates improved treatment outcomes when clinicians use EBTs compared to standard practice (Cary & McMillen, 2012; Weisz, Jensen-Doss, & Hawley, 2006).
The fields of child trauma and maltreatment have made great strides in developing and promoting EBTs. For instance, the establishment of the National Child Traumatic Stress Network (NCTSN) by the United States Congress in 2001 significantly increased the visibility and dissemination of EBTs for trauma-exposed children. A number of EBTs were identified, and significant resources were allocated to clinics and training centers across the country to promote their use. Moreover, the National Children’s Alliance, the national accrediting agency for children’s advocacy centers (CACs), recently revised their standards for the implementation of mental health services for maltreated children. The updated standards require that psychotherapeutic services be evidence based and informed by the latest research on childhood trauma and abuse.
Despite the empirical research on EBTs and the significant pressure exerted by policymakers to increase their use, it appears that changing the practices and attitudes of clinicians who serve trauma-exposed children is a slow process. A recent study found that out of 250 clinicians who provide services for maltreated children, less than one-third could identify more than one EBT (Allen, Gharagozloo, & Johnson, 2012). In addition, the majority of clinicians reported that they had received training in and regularly employed interventions that are not considered evidence based. Of those clinicians who did report using an EBT (specifically, trauma-focused cognitive behavioral therapy), 33% self-reported a lack of fidelity to the treatment model (Allen & Johnson, 2012).
The lack of knowledge about and implementation of available EBTs may be due partially to dissemination methods that are not effective in reaching many mental health professionals. Allen and Armstrong (2014) found that clinicians identified case studies demonstrating the use of a treatment as the most desired form of evidence when selecting an intervention. Clinicians reported reading twice as many case studies as data-based research reports and generally obtained these case studies from published books. Although the developers of EBTs have successfully conducted several randomized clinical trials that demonstrate the superiority of EBTs over other treatments, they rarely provide complete case studies that discuss how these approaches are used. Rather, journal articles and published treatment manuals typically include only brief vignettes demonstrating the use of a particular skill or technique. Such examples, while clinically useful, are unable to fully explain how EBTs are used with culturally diverse, complex, or challenging families. Furthermore, the vignettes do not typically show modifications of the treatment protocol for specific clinical concerns or how to maintain fidelity to the model when modifications are made.
Our book attempts to address these concerns by providing complete case studies of EBTs as well as sufficient background for clinicians to understand an evidence-based approach to treatment. The book is divided into four parts. Part I provides an introduction to evidence-based treatments and has a chapter on the nature and development of EBTs and a chapter that highlights the critical role of assessment in providing evidence-based care. Parts II through IV cover three prominent EBTs for trauma-exposed children: trauma-focused cognitive-behavioral therapy (TF-CBT), child–parent psychotherapy (CPP), and parent–child interaction therapy (PCIT). Each part begins with an overview of the techniques and research base of the EBT and is followed by two chapters with case studies. In each case study, “real-world” clients are followed from intake to discharge, and the reader is able to examine how the clinician maintained fidelity to the treatment model and overcame typical barriers to treatment implementation, including cultural issues, unexpected clinical events, reluctant caregivers, and comorbid clinical presentations.