儿童及青少年行为

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Are Complex Multimodal Interventions the Best Treatments for Mental Health Disorders in Children and Youth?

Peter H Silverstone, Victoria YM Suen, Chandra K Ashton, Deena M Hamza, Erin K Martin and Katherine Rittenbach

There is a pressing need for effective interventions to treat mental health disorders in children and youth. There is evidence for increasing incidence rates across a wide range of conditions, and these can lead to very significant long-term impacts. They include depression, anxiety, abuse of drugs and alcohol, and the impacts of a variety of traumas. Recently we have carried out a number of studies in which complex and multimodal interventions were either introduced and then studied, or were on-going but hadn’t previously been rigorously tested for efficacy. Here we present a review based upon some of these multimodal programs which examined outcomes in: (1) a schoolbased program to reduce depression and suicidal thinking in youth aged 11-17 years old in which all students were screened on an electronic tablet using standard scales for depression and suicidal thinking followed by the option of an internet-based cognitive behavioural program; (2) a screening, brief intervention and referral to treatment (SBIRT) program to help youth aged 11-17 years old who had significant drug and/or alcohol abuse in which initial screening for drug and alcohol use was followed by the options of an internet-based cognitive behavioural program and referral to child and adolescent specialists; and (3) outcomes following trauma experienced by children aged 5-12 years old in two separate programs in which a complex intervention was used involving 2-3 hours of weekly interventions for both the child and a primary care-giver. The depression, suicidal thinking, and drug and alcohol results were from a large school-based program involving over 6,200 youth termed the Empowering a Multimodal Pathway Towards Healthy Youth (EMPATHY) program, for which 15-month outcomes are recently available. The other two programs treated child victims of trauma. These were firstly in an intensive 8-12 month outpatient intervention program with 50 children aged 5-11 years old who developed an attachment disorder following trauma, given in a dyad model involving their primary caregiver. Secondly, in a 12-month program for 40 children aged 8-12 years old who were victims of childhood sexual abuse, which included intermittent residential treatment. The details of the programs varied greatly, but all involved multimodal methods of treatment. In terms of outcomes, all of these programs found significant longer-term improvements in multiple areas. In conclusion, our findings from this review suggest that future research and clinical programs should consider multimodal approaches for the treatment of mental health disorders in children and youth, and future research should directly compare such programs to individual therapeutic approaches.