Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Services Interventions
Treatment Interventions
Outpatient Treatment
The term “outpatient treatment” covers a large variety of therapeutic
approaches, with most falling into the broad theoretical categories of the
psychodynamic, interpersonal, and behavioral psychotherapy. Outpatient
psychotherapy is the most common form of treatment for children and adolescents,
utilized annually by an estimated 5 to 10 percent of children and their families
in the United States (Burns et al., 1998). It is also the most extensively
studied intervention and, with over 300 studies, has the strongest research base
(Weisz et al., 1998). Outpatient therapy is offered to individuals, groups, or
families, usually in a clinic or private office. The duration of treatment
varies from 6 to 12 weekly sessions to a year or longer. Newer outpatient
interventions (e.g., case management, home-based therapy) that were developed
more recently for youth with severe disorders are provided with greater
frequency (i.e., daily) in the home, school, or community. Those interventions
are reviewed later in this chapter.
The strongest support for the effectiveness of outpatient treatment comes from a
series of meta-analyses. Meta-analyses are an important type of research
methodology, described in Chapter 1, that enable one to combine research
findings from separate studies. Nine meta-analyses, published between 1985 and
1995, probed the effectiveness of research on individual, group, and family
therapy for children and adolescents (Casey & Berman, 1985; Hazelrigg et al.,
1987; Weisz et al., 1987; Kazdin et al., 1990; Baer & Nietzel, 1991; Grossman &
Hughes 1992; Shadish et al., 1993; Weisz & Weiss, 1993; Weisz et al., 1995).
Although these meta-analyses vary in time period, age groups, and meta-analytic
approach, they were largely restricted to studies of treatment given in a
research clinical setting, and their findings are relatively consistent. The
major findings indicated that the improvements with outpatient therapy are
greater than those achieved without treatment; the treatment is highly
effective, as was found in meta-analyses of adults (Brown, 1987); and the
effects of treatment are similar, whether applied to problems such as anxiety,
depression, or withdrawal (internalizing problems) or to hyperactivity and
aggression (externalizing problems) (Kazdin, 1996).
Given strong evidence of efficacy for outpatient treatment, the question of
applicability to real-world settings has been examined. A meta-analysis was
performed on studies of the effectiveness of various types of outpatient
treatment, regardless of whether their efficacy had been established through
research (Weisz et al., 1995). The researchers were able to identify only nine
studies of treated children in nonresearch clinical settings where therapy was a
regular service of the clinic and was carried out by practicing clinicians.
Those nine studies demonstrated little or no effect. Clearly, real-world therapy
was found to be less effective than that provided through a research protocol. A
variety of factors may account for the gap, including less attention in
real-world settings to careful matching of patients with treatments, less
adherence to a treatment protocol, and less followup care.
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