Brain Story Certification: Module 9

Module 9

Excerpt from “Lessons Learned in the Development & Implementation of Preventive Interventions for Maternal Depression” William Beardslee, MD

• No child is damaged by a parent’s depression.
• Strengths-based approaches are important.
• Prevention of a child’s mental illness through mental health promotion is cost-effective.
• Needs to be developmentally appropriate.
• Build a positive sense of self-esteem, mastery, well-being, and social inclusion.
• Strengthen the ability to cope with adversity.
• Promotion, Prevention, treatment, and maintenance are all pieces of the puzzle
• Interventions can take place over the lifespan:
• Parenting programs – Triple P

Excerpt from “Lessons Learned in the Development & Implementation of Preventive Interventions for Maternal Depression” William Beardslee, MD Harvard University.

• Preventative strategies can include:
  • Treating parents
  • Providing help with parenting
  • Using a two-generational approach
• Depression prevention can be an outcome of another intervention (e.g. job retraining, bereavement).
• Broader approaches look at the whole life development of all family members. Examples can include Family talk, prevention of depression, parent/child coping session, & mothers’ and babies’ program.
• Interventions need to consider the mental health of the parent before the delivery of services.
• Childhood interventions include Early Head Start/Head Start, The Incredible Years, Family connections, Wellness and Babies Program. Brief and focused can have a positive impact.

Excerpt from “Promoting Youth Well-Being Through Psychotherapy” John Weisz, PhD Judge Baker Children’s Center, Harvard University

• Two treatment streams
  • Usual Care – non-directive supports without a significant research base
  • Evidence-based Treatments – Scientifically-tested – most are for one specific type of disorder (about 50 EBTs exist).
  • Evidence-based has a manual with a plan, model.
    • Session agenda set by the therapist with client input
    • Focus on specific skill-building
    • Talk, role-play, in vivio, HW
    • Theory-guided and narrow focus
    • Typically, 15-25 sessions, with components, and elements
  • Usual clinical care is:
    • From training, and practice
    • Relatively unstructured
    • Session shaped by client
    • Focus on understanding, supporting, encouraging
  • Cognitive reframing is a commonly used evidence-based treatment
  • Childhood psychotherapy falls within the range of effectiveness as is seen in adults.

Excerpt from “Promoting Youth Well-Being Through Psychotherapy” John Weisz, PhD Judge Baker Children’s Center, Harvard University

• Evidence-based treatments are rarely used in everyday clinical practice (about 5%).
• When EBTs are used there are complexities that reduce the effectiveness.
• It is still better than treatment as usual, but not as good as in research trials for the intervention.
• Influencing factors include – child factors, therapist factors, family factors, stress/life factors, and clinic factors.
• Challenges to practice – many clinicians treat multiple disorders in a typical day/week. It is intensive to learn each treatment protocol is difficult.
• Comorbidity barriers
• Flux – the problems change during treatment. Single EBT is difficult to put into practice
• Practice is not linear!

Excerpt from “Promoting Youth Well-Being Through Psychotherapy” John Weisz, PhD Judge Baker Children’s Center, Harvard University

Improving EBP effectiveness in clinical care

Challenges

• Address diverse clinician caseloads
• Address comorbidity in treated youths
• Address flux/shifts in youth problems during treatment

An approach

• Integrating EBTs
• Reduce complexity/redundancy
• Look at problem clusters with common EBP interventions

What are the core skills that children need to facilitate better development?

Clinician feedback tools can help highlight when an intervention is relevant.  One example is Treatment Response Assessment for Children (TRAC)

Excerpt from “The Pivot to Preemptive Treatments in Psychiatry” John Steven March, MD, MPH Duke Clinical Research Institute, Duke University.

• Prevention involves a way of thinking that goes beyond the traditional disease model, in which one waits for an illness to occur and then provides evidence-based treatment.
• Seek to approach mobility, mortality through impacting the trajectory development.
• Needs a biologically-based theory of disease
• Look at predictive tools in the form of biomarkers or biosignatures
• Novel interventions to prevent or alter course of an illness
• Do the interventions address the phenotype?
• What creates a change towards preemptive interventions:
  • Translational developmental neuroscience
  • Biomarkers and personalized medicine
• Often individuals first receive treatment 10 years into the development of a disorder.
• Disorders can be neurodevelopmental in their timelines
• Early interventions that work with the sensitive period are more impactful.
• The insult to the system (biological, environmental, or otherwise that impact allostatic load) leads to entering an altered developmental trajectory