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Evaluation ViewAttendees 3

Category: Translational

Symposium 76 - Accelerating Collaboration in Mental Health Treatment Design: The Most Overlooked Benefit of Modularity

Saturday, November 18, 2023
12:30 PM – 2:00 PM PST
Location: Elwha A, Level 5
CE: 1.5

Keywords: Treatment/ Program Design, Treatment Development, CBT
Level of Familiarity: All
Recommended Readings: Becker, K. D., & Chorpita, B. F. (2023). Future Directions in Youth and Family Treatment Engagement: Finishing the Bridge Between Science and Service. Journal of Clinical Child & Adolescent Psychology, 1-26.,   Chorpita, B. F., & Daleiden, E. L. (2014). Structuring the collaboration of science and service in pursuit of a shared vision. Journal of Clinical Child & Adolescent Psychology, 43(2), 323-338.,   Hogue, A., Bobek, M., Dauber, S., Henderson, C. E., McLeod, B. D., & Southam-Gerow, M. A. (2019). Core elements of family therapy for adolescent behavior problems: Empirical distillation of three manualized treatments. Journal of Clinical Child & Adolescent Psychology, 48(1), 29-41.,   Shafran, R., Bennett, S., Coughtrey, A., Welch, A., Walji, F., Cross, J. H., ... & Moss-Morris, R. (2020). Optimising evidence-based psychological treatment for the mental health needs of children with epilepsy: principles and methods. Clinical Child and Family Psychology Review, 23, 284-295.,   Bennett, S. D., Cross, J. H., Coughtrey, A. E., Heyman, I., Ford, T., Chorpita, B., ... & Shafran, R. (2021). MICE—Mental Health Intervention for Children with Epilepsy: a randomised controlled, multi-centre clinical trial evaluating the clinical and cost-effectiveness of MATCH-ADTC in addition to usual care compared to usual care alone for children and young people with common mental health disorders and epilepsy—study protocol. Trials, 22(1), 1-16.

As of 2022, the youth mental health evidence base of 1,474 randomized trials featured 1,858 active treatments attributed to 6,382 named authors. Two notable observations are: (1) treatments on average have fewer than four authors, and (2) the clinical procedures that are represented with any frequency in this evidence base are roughly only about 45. Thus, the mental health literature is enormously fragmented, characterized by a vast number of experts authoring many hundreds of products, yet representing only a limited set of concepts. As all human endeavors move increasingly toward knowledge-centric approaches for using evidence to solve problems, it will be important to find ways to coordinate the best work from vast networks of intervention developers and the resulting fragmented array of clinical products to yield reliable, robustly-supported, streamlined, and actionable recommendations that guide clinical practice. Modular intervention design accelerates this collaboration and coordination among experts by enforcing four specific design principles, allowing different parts to work together (“standardized interface”), indicating clearly denoted functions (“proper functioning”), enforcing standardized sub-elements (“partial decomposability”), and selectively hiding details that are not relevant to all members of an intervention design team (“information hiding”). These principles allow laboratories with diverse and independent expertise to collaborate asynchronously and even anonymously to efficiently produce intervention systems that can be extended and configured for many new contexts with minimal redesign of components and essentially no change to the intervention framework. These four papers represent intervention development teams who leveraged aspects of modular design to produce novel interventions that seamlessly extend from or connect to other intervention systems, and as such, point to a possible future of a de-fragmented evidence base in which expertise accumulates rather than merely competes. The authors provide examples of how, even in an academic context that incentivizes differentiation, we can focus our expertise, efforts, and investments on the most innovative extensions of evidence-based treatment, rather than continually re-inventing much of it. These efforts hint at possibilities for provider and family experiences to be improved through systems that could deliver the entire evidence base through a single interface or medium of one's choosing, ultimately allowing scientists, providers, and the public to collaborate more efficiently and productively in the shared endeavor of reducing mental health burden and promoting healthier lives and stronger communities.

Learning Objectives:

At the end of the session, the learner will be able to:
  • Discuss how modularity can leverage more of the evidence base than what is represented by any single evidence-based treatment.
  • Discuss how modularity can combine the best of both evidence-based treatments and individualized care models to extend their impact.
  • Describe shared decision-making and how modular designs support therapist-family collaboration.
  • Describe the derivation and content of four modules of manualized family therapy for adolescent substance use and behavior problems.
  • Consider how modules can be developed with input from patients and clinicians to ensure interventions are acceptable.
  • Discuss how the addition of new modules to existing evidence based therapies has been used in a physical healthcare setting.