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Evidence Based Practices: Clinical Tools and Interventions

This section highlights current clinical tools and interventions in the area of child and youth mental health. Wherever possible, we've provided Canadian resouces, some of which were developed by CMHO's EBP Working Group. Whether you're a teacher working in public education, or a social worker who is on staff at a children's mental health centre, these resources will be invaluable to your work with children and youth.

Accountability

Accountability of Specialist Child and Adolescent Mental Health Services

Outcome auditing of specialist child and adolescent mental health services (CAMHS) is now well under way internationally. There is, however, debate about objectives and tools. A case is made for the achievable goal of enhancing service accountability through user satisfaction information and clinician-rated contextualised measures of improvements in symptoms and impairment.

Garralda, E. M. : The British Journal of Psychiatry 194: 389-391 (2009)

Article (PDF, 4 pages)

A Culture of Accountability

Describes the critical success factors and indicators that must be present in an organization for it to be highly accountable. Designed to help children's mental health organizations better understand, measure, celebrate and build accountability. Provides funders a lens through which to view accountability within the organizations they support.

Armstrong, R. & Mollenhauer, L. Toronto, Ontario, Canada: Children's Mental Health Ontario(June, 2006)

Entire Report (PDF, 18 pages)
Insert (PDF, 2 pages)
Rapport en entier (PDF, 19 pages)

Accountability Assessment Tool

Provides Board members and staff with an opportunity to reflect on accountability within the organization, and to identify strengths and areas for improvement. This process of reflection will lead to a practical action plan for strengthening accountability.

Toronto, Ontario, Canada: Children's Mental Health Ontario(June, 2006)

Accountability Assessment Tool (PDF, 19 pages)
in French (PDF, 18 pages)

Addiction, Gambling, Risk-Taking Behaviour

Addiction Toolkit

This toolkit is for health care providers who work in a primary care setting and who have patients with substance use problems. Based on current clinical evidence and the extensive clinical experience of the editors and contributors, the toolkit provides brief answers to common clinical questions, as well as relevant clinical tools and patient resources. It currently focuses on four topic areas (see below) but will continue to expand over time.

Toronto/Ontario : CAMH and St. Joseph's Health Centre(2010)

Fundamentals of addiction (HTML)
Dealing with alcohol problems (HTML)
Smoking cessation (HTML)
Opioid misuse and addiction (HTML)

Youth & Drugs and Mental Health: A Resource for Professionals

Provides up-to-date information about addressing substance use among young people - including doing so in the context of other mental health problems that they may be experiencing. Draws upon available published information and integrates it with the advice of experts who work in addiction and mental health programs for youth. Divided into three main sections - excerpts from Part 1 and 2 can be downloaded for free; Part 3 ("First Contact: A Brief Treatment for Young Substance Users with Mental Health Problems") can be downloaded for free in its entirety.

Toronto, Canada: Centre for Addiction and Mental Health(2004)

Link to Order Information (HTML, 1 page)
Part 1 - Chapter 1: Overview of Youth Substance Use and Mental Health Problems (PDF, 13 pages)
Part 3 - First Contact: A Brief Treatment for Young Substance Users with Mental Health Problems (PDF, 58 pages)

Anxiety Disorders

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders

This revised practice parameter reviews the evidence from research and clinical experience and highlights significant advancements in the assessment and treatment of anxiety disorders since the previous parameter was published. It highlights the importance of early assessment and intervention, gathering information from various sources, assessment of comorbid disorders, and evaluation of severity and impairment. It presents evidence to support treatment with psychotherapy, medications, and a combination of interventions in a multimodal approach.

Washington, DC, USA: J. Am. Acad. Child Adolesc. Psychiatry(February, 2007)

Practice Parameter (PDF, 17 pages)

Practice Parameters for the Assessment and Treatment of Children and Adolescents With Obsessive-compulsive Disorder

These practice parameters describe the assessment and treatment of obsessive-compulsive disorder based on a detailed literature review and expert consultation. Obsessive compulsive disorder is a disorder of heterogeneous origin characterized by intrusive thoughts or compulsive urges or behaviors that are distressing, time-consuming, or functionally impairing. In children and adolescents, the disorder often is accompanied by a wide range of comorbidity, including mood, anxiety, attention, and learning difficulties, and/or tic disorder. These parameters describe the relevant areas of assessment, especially symptomatology, onset and course, other associated psychopathology, and developmental, family, and medical history (including post-infectious onset or exacerbations). Only two modalities have been systematically assessed and empirically shown to ameliorate core symptoms: cognitive behavioral therapy (primarily exposure/response prevention) and serotonin re-uptake inhibitor medication. Data regarding the indications, efficacy, and implementation of these modalities are reviewed. Because of the frequent co-occurrence of other psychopathology and adaptive difficulties, additional educational, individual and family psychotherapeutic, and pharmacological interventions often are necessary. Treatment planning guidelines are provided.

Washington, DC, USA: American Academy of Child and Adolescent Psychiatry(1998)

Practice Paramter (PDF, 38 pages)

Attention Deficit/Hyperactivity Disorder (AD/HD)

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

This practice parameter describes the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) based on the current scientific evidence and clinical consensus of experts in the field. This parameter discusses the clinical evaluation for ADHD, comorbid conditions associated with ADHD, research on the etiology of the disorder, and psychopharmacological and psychosocial interventions for ADHD.

Washington/DC, USA: J. Am. Acad. Child Adolesc. Psychiatry(July, 2007)

Practice Parameter (PDF, 28 pages)

Autism

Evidence Based Practices for Children and Adolescents with Autism Spectrum Disorders - Review of the Literature and Practice Guide

The purpose of this guide is to provide a summary of empirically based assessment and intervention approaches for children and adolescents with Autism Spectrum Disorders (ASDs) and best practices for supporting families. Primarily intended for mental health professionals in the children's mental health sector, but will also be useful for parents and professionals in other sectors who provide services to children with ASDs and their families.

Perry, A. & Condillac, R. Toronto, Ontario, Canada: Children's Mental Health Ontario(2003)

Entire Report (PDF, 113 pages)
Rapport en entier (PDF, 132 pages)

Practice Parameters For The Assessment And Treatment Of Children, Adolescents, And Adults With Autism And Other Pervasive Developmental Disorders

Autism and the related pervasive developmental disorders (PDDs) are characterized by patterns of delay and deviance in the development of social, communicative, and cognitive skills, which arise in the first years of life. Although frequently associated with mental retardation these conditions are distinctive in terms of their course and treatment. These conditions have a wide range of syndrome expression and their management presents particular challenges for clinicians. Individuals with these conditions can present for clinical care at any point in development. The multiple developmental and behavioral problems associated with these conditions often require the care of multiple providers; coordination of services and advocacy for individuals and their families is important. Early, sustained intervention is indicated as is the use of various treatment modalities (e.g., pharmacotherapy, special education, speech-communication therapy, and behavior modification).

Washington, DC, USA: American Academy of Child and Adolescent Psychiatry(1999)

Practice Parameter (PDF, 59 pages)

Bullying

Assessment Toolkit for Bullying, Harassment, and Peer Relations at School

This toolkit is a companion document to the CPHA Safe School Study Research Report. It was designed for teachers, school administrators, and ministries of education to address some of the pressing needs identified in that Report. The toolkit provides a standard way to measure the nature and prevalence of peer relationship problems, standards for quality programs, and a common set of tools to assess the impact of school-based programs.

Totten, Dr. M. et al. Ottawa, Ontario, Canada: Canadian Public Health Association(2004)

Assessment Toolkit (English) (PDF, 170 pages)
Assessment Toolkit (French) (PDF, 170 pages)

Conduct Disorder (CD)

Cognitive Behavioural Approaches to Treating Children & Adolescents with Conduct Disorder

The goal of this manual is to help you understand Cognitive Behavioural (CB) therapy and how this treatment approach can be applied to children and youth diagnosed with Conduct Disorder (CD).

Baker, L. & Scarth, K. Toronto, Ontario, Canada: Children's Mental Health Ontario(2002)

Entire Report (PDF, 140 pages)

Evidence Based Practices for the Treatment of Conduct Disorder in Children and Adolescents

This document was produced by CMHO's EBP Committee and identifies Evidence Based Practices for children and adolescents with Conduct Disorder. It will assist children's mental health professionals in their daily work with this challenging population.

Toronto, Ontario, Canada: Children's Mental Health Ontario(May 1, 2001)

Entire Report (PDF, 92 pages)
Findings (PDF, 32 pages)
Clincial Pathways (PDF, 2 pages)
Training Programs (PDF, 30 pages)
Group Interventions (PDF, 19 pages)
Summary (PDF, 5 pages)

Practice Parameters for the Assessment and Treatment of Children and Adolescents With Conduct Disorder

These practice parameters address the diagnosis, treatment, and prevention of conduct disorder (CD) in children and adolescents. A voluminous literature addresses the problem from a developmental, epidemiological, and criminological perspective. Properly designed treatment outcome studies of modern psychiatric modalities are rare. Ethnic issues are mentioned, but not fully addressed from a clinical perspective. Clinical features of conduct-disordered youth include predominance in males, low socioeconomic status, and familial aggregation. Important continuities to oppositional defiant disorder and antisocial personality disorder have been documented. Extensive comorbidity, especially with other externalizing disorders, depression, and substance abuse, has been documented and has significance for prognosis. Clinically significant subtypes exist according to age of onset, overt or covert conduct problems, and levels of restraint exhibited under stress. To be effective, treatment must be multimodal, address multiple foci, and continue over extensive periods of time. Early treatment and prevention appear more effective than later intervention.

Washington, DC, USA: J. Am. Acad. Child Adolesc. Psychiatry(October, 1997)

Practice Parameter (PDF, 18 pages)

Early Childhood Mental Health

There is convincing research evidence about the importance of early childhood development for laying the foundation for competence and coping skills throughout life. There is equally convincing evidence about the influence of the period from birth to six on antisocial behaviour and mental health problems later in life. Early childhood mental health services aim to enhance the well-being of all children, and minimize or avoid behavioural and emotional problems in children with special needs.

Early Childhood Mental Health Treatment - Literature Review and Practice Guide

This document was produced under the guidance of an Advisory Committee and incorporates input from a panel of experts and regional consultation groups. The authors conducted reviews of the research and practice literature in Canada and elsewhere to identify best practices and key principles that lead to successful treatment outcomes for infants and young children and their families.

Toronto, Ontario, Canada: Children's Mental Health Ontario(March, 2002)

Entire Report (PDF, 61 pages)
Rapport en entier (PDF, 67 pages)

Early Childhood Mental Health Treatment - Training Reference Guide

With input from front-line clinicians who are experienced in community-based mental health services for young children, the authors translated the practice guidelines of the Early Childhood Mental Health Treatment - Literature Review and Practice Guide into an effective training program.

Toronto, Ontario, Canada: Children's Mental Health Ontario(Summer, 2002)

Entire Report (PDF, 117 pages)
Rapport en entier (PDF, 137 pages)

Knowledge Transfer, Knowledge Exchange, & EBP Implementation

The transfer of knowledge about, and the actual implementation of Evidence-Based Practices are highly complex processes. CMHO believes that the study of these processes is just as important as the study of the evidence-based practices themselves.

Knowledge Transfer and Implementation of Evidence-Based Practices in Children's Mental Health

A very important part of CMHO's work has been to ensure that a bridge is built between research and practice. This project is a collaborative effort funded by CMHO under the guidance of CMHO's EBPWG, the Community Health Systems Resource Group at the Hospital for Sick Children, and the National Implementation Research Network/Louis de la Parte Florida Mental Health Institute at the University of South Florida. Project objectives include: Review literature in knowledge transfer, organizational change, and implementation science; Survey leaders and practitioners in CMHCs across Ontario regarding their: utilization of research-based information; readiness for change; Interview experts in implementation science; Make recommendations for system of care improvements.

Toronto/Ontario, Canada: Children's Mental Health Ontario

Gauging Interest in Communities of Practice: Regional feedback (PDF, 21 pages)

As part of the KT Workshops, participatory discussions were held to assess regional interest in cultivating communities of practice. Participant feedback is collated in this document (Ruffolo, F. Toronto, Ontario, Canada: Children's Mental Health Ontario, 2006).

Knowledge Transfer and Implementation of Evidence-Based Practices in Children's Mental Health (PDF, 47 pages)
This presentation was given at workshops throughout Ontario, and provides an overview of the full report: Knowledge Transfer and Implementation of Evidence-Based Practices in Children's Mental Health (Barwick, M. Toronto, Ontario, Canada: SickKids (2005)).
Knowledge Transfer and Implementation of Evidence-Based Practices in Children's Mental Health (138 pages) (PDF)
Drawing on the experience and wisdom of several prominent experts, this document is an important first step in understanding the barriers and facilitators that are relevant to the implementation of EBP in Ontario's children’s mental health centres. It provides: a comprehensive review of the literature on knowledge transfer; the results from survey of executive directors and clinical staff in children’s mental health centres (Barwick, M.A., Boydell, K.M., Stasiulis, E., Ferguson, H.B., Blase, K., & Fixsen, D. Toronto, Ontario, Canada: Children's Mental Health Ontario (2005)). Rapport en entier (150 pages), Bibliography (96 pages), Summary (16 pages).

Implementing Evidence-Based Practice in Children's Mental Health

Despite widespread acknowledgement that health practitioners need to be informed of the best currently available research evidence, implementing evidence-based practice (EBP) can be a challenge in real-world settings. This report focuses on implementing EBP in children’s mental health. The authors identified systematic reviews published between 1999-2003 on the topic of implementing EBP in a variety of health settings applicable to children’s mental health. To be included, systematic reviews had to meet a high standard involving a description of the search strategy and a list of criteria used to select original studies for detailed review. Reviews also had to include at least two randomized controlled trials.

Waddell, C., Godderis, R., Wong, W., & Garland, O. Vancouver, BC, Canada: Children's Mental Health Policy Research Program, University of British Columbia(November, 2005)

Full Report (PDF, 20 pages)

Implementation Research: A synthesis of the literature

This monograph summarizes findings from the review of the research literature on implementation: It describes the current state of the science of implementation, and identifes what it will take to transmit innovative programs and practices to mental health, social services, juvenile justice, education, early childhood education, employment services, and substance abuse prevention and treatment.

Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., Wallace, F. Tampa, Florida, United States: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network(2005)

Entire Report (PDF, 125 pages)

Evidence-Based Practice in Child and Adolescent Mental Health Services

The authors review the status, strength, and quality of evidence-based practice in child and adolescent mental health services.

Hoagwood, K. et al. Arlington, VA, USA: Psychiatric Services, 52:1179-1189(September, 2001)

Link to Article (PDF, 11 pages)

Mood Disorders (Depression, Bipolar Disorder (Manic-Depression))

Guide Lines for Adolescent Depression in Primary Care (GLAD-PC)

The purpose of this project is to develop clinical guidelines in primary care for the management of Major Depressive Disorder and/or Dysthymia in adolescents aged 10-21. The guidelines address issues regarding screening, diagnosis and treatment of these disorders, and recommendations derived from these guidelines focus on barriers of a clinical, organizational and systemic nature. Recommendations are published in Pediatrics 2007, Nov,120(5):e1299-e1326.

Jensen, P., Cheung, A., Levitt, A., & Zuckerbrot, R.

GLAD-PC Methods (PDF, 5 pages)

Developing Evidence- and Consensus-based Guidelines for the Management of Adolescent Depression - Primary Care (GLAD-PC)

GLAD-PC Toolkit (PDF, 141 pages)

Treating Child and Adolescent Depression: A handbook for children

A practical resource for children's mental health practitioners who work with children and adolescents with depression. Topics covered include: multidisciplinary consultation, safety planning, loss and trauma, and family interventions. Case examples are used to illustrate effective strategies for treatment. A 'toolkit' for children's mental health practitioners is provided.

Baker, L. & Ashbourne, L. Toronto, Ontario, Canada: Children's Mental Health Ontario(2002)

Entire Report (PDF, 154 pages)

Evidence Based Practices for the Treatment of Depression in Children and Adolescents

This document was produced by CMHO's EBP Committee and identifies Evidence Based Practices for children and adolescents with Depressive Disorder. It will assist children's mental health professionals in their daily work with this challenging population.

Toronto, Ontario, Canada: Children's Mental Health Ontario(May, 2001)

Entire Report (PDF, 45 pages)
Findings (PDF, 34 pages)
Clinical Pathways (PDF, 2 pages)
Summary of findings (PDF, 6 pages)

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders

This practice parameter describes the epidemiology, clinical picture, differential diagnosis, course, risk factors, and pharmacological and psychotherapy treatments of children and adolescents with major depressive or dysthymic disorders. Side effects of the antidepressants, particularly the risk of suicidal ideation and behaviors are discussed. Recommendations regarding the assessment and the acute, continuation, and maintenance treatment of these disorders are based on the existent scientific evidence as well as the current clinical practice.

Washington, DC, USA: J. Am. Acad. Child Adolesc. Psychiatry(November, 2007)

Practice Parameter (Audio, 24 pages)

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder

This practice parameter reviews the literature on the assessment and treatment of children and adolescents with bipolar disorder. The parameter focuses primarily on bipolar 1 disorder because that is the type most often studied in juveniles. The presentation of bipolar disorder in youth, especially children, is often considered atypical compared with that of the classic adult disorder, which is characterized by distinct phases of mania and depression. Children who receive a diagnosis of bipolar disorder in community settings typically present with rapid fluctuations in mood and behavior, often associated with comorbid attention-deficit/hyperactivity disorder and disruptive behavior disorders. Thus, at this time it is not clear whether the atypical forms of juvenile mania and the classic adult form of the disorder represent the same illness. The question of diagnostic continuity has important treatment and prognostic implications. Although more controlled trials are needed, mood stabilizers and atypical antipsychotic agents are generally considered the first line of treatment. Although patients may respond to monotherapy, combination pharmacotherapy is necessary for some youth. Behavioral and psychosocial therapies are also generally indicated for juvenile mania to address disruptive behavior problems and the impact of the illness on family and community functioning.

Washington, DC, USA: J. Am. Acad. Child Adolesc. Psychiatry(January, 2007)

Practice Parameter (PDF, 19 pages)

Oppositional Defiant Disorder (ODD)

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is a common clinical problem in children and adolescents. Oppositionality and associated types of aggressive behavior are among the most common referral problems in child psychiatry. Grouped among the disruptive behavior disorders, ODD is frequently comorbid with other psychiatric conditions and often precedes the development of conduct disorder (CD), substance abuse, and severely delinquent behavior. Youth with ODD may also have specific CD behaviors, such as aggression. Although compared with CD there exists a smaller and less sophisticated empirical database for ODD, this parameter draws upon the existing ODD and CD literature to make recommendations regarding diagnosis and treatment of ODD. The etiology of ODD is complex and its development is based on a cumulative risk/protective factor model that combines biological, psychological, and social factors. Recommended treatment is multimodal and extensive, involving individual and family psychotherapeutic approaches, medication, and sociotherapy. Methodologically sound controlled clinical trials are lacking.

Washington, DC, USA: J. Am. Acad. Child Adolesc. Psychiatry(January, 2007)

Practice Parameter (PDF, 16 pages)

PostTraumatic Stress Disorder (PTSD)

Practice Parameters for the Assessment and Treatment of Children and Adolescents With Posttraumatic Stress Disorder

Since the introduction of posttraumatic stress disorder (PTSD) as a diagnostic category in DSM-III (American Psychiatric Association, 1980), there has been a growing awareness that children and adolescents as well as adults can experience this disorder. Because it is a relatively new diagnosis, because the diagnostic criteria have changed with each DSM revision since 1980, and particularly because developmental factors may significantly impact on the clinical presentation of this disorder, practice parameters can be of value in assisting clinicians in the diagnosis and treatment of childhood PTSD, and as a result, also be of value to the children and families of children who develop this disorder.

Washington/DC, USA: American Academy of Child and Adolescent Psychiatry(1998)

Practice Parameter (PDF, 52 pages)

Schizophrenia

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Schizophrenia

This practice parameter reviews the literature on the assessment and treatment of children and adolescents with schizophrenia. Recommendations are based on the limited research available, the adult literature, and clinical experience. Earlyonset schizophrenia is diagnosed using the same criteria as in adults, and it appears to be continuous with the adult form of the disorder. Noted characteristics of youth with schizophrenia include predominance in males, high rates of premorbid abnormalities, and often poor outcome. Differential diagnosis includes psychotic mood disorders, developmental disorders, organic conditions, and nonpsychotic emotional/behavioral disorders. Treatment strategies incorporate antipsychotic medications with psychoeducational, psychotherapeutic, and social and educational support programs. The advent of atypical antipsychotic agents has enhanced the potential for effective treatment.

Washington/DC, USA: J. Am. Acad. Child Adolesc. Psychiatry(July, 2001)

Practice Parameter (PDF, 20 pages)

Self-Harm, Suicide, Suicide Prevention

Aboriginal Youth: A Manual of Promising Suicide Prevention Strategies

This manual was written for people who want to develop and implement suicide prevention programs; it presents information in a positive, culturally respectful and straightforward way.

Jodoin, N. & White, J Calgary, Alberta, Canada: Centre for Suicide Prevention, Suicide Prevention Training Programs(2003, Revised 2004)

English Document (PDF, 288 pages)
French Document (PDF, 287 pages)

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Suicidal Behavior

These guidelines review what is known about the epidemiology, causes, management, and prevention of suicide and attempted suicide in young people. Detailed guidelines are provided concerning the assessment and emergency management of the children and adolescents who present with suicidal behavior. The guidelines also present suggestions on how the clinician may interface with the community. Crisis hotlines, method restriction, educational programs, and screening/ case-finding suicide prevention strategies are examined, and the clinician is advised on media counseling. Intervention in the community after a suicide, minimization of suicide contagion or imitation, and the training of primary care physicians and other gatekeepers to recognize and refer the potentially suicidal child and adolescent are discussed.

Washington/DC, USA: J. Am. Acad. Child Adolesc. Psychiatry(July, 2001)

Practice Parameter (PDF, 28 pages)

For Professionals