Interventions – summary
Lecture 1 + Chapter 1 (p1-10) Weisz + article Weisz et
al (2017)
Dutch children are amongst the happiest children in the world. However, there are still
children in need. 15% of the children need any kind of help. 5% of the children need
specialized help. The goal of the transformation of the youthcare in The Netherlands was to
have less children in the specialized youthcare. This goal isn’t reached, the amount is more or
less the same.
The most common reason children are referred to care is behaviour problems. Please note that
this is the reason they are coming in to the youthcare, the reason for these problems can be
something else. The most common problem in children is anxiety. This is, however, not a
very visible problem and doesn’t always give a lot of problems for the environment. This
leads to the fact that children with anxiety problems are less likely to be referred to care.
It is important to intervene (early on), because:
- Mental health disorders among youths 10-24 years of age are the leading cause of
disease burden
o Interferes with social and academic functioning
- Mental health disorders have long-term effects on adult functioning (see figure)
This figure shows that kids who had disorders in childhood have more problems as adults than
kids who had nothing in their childhood. Also children who are in the subthreshold show
more problems in adulthood. (Big smokey mountain study; Copeland et al., 2015)
Subthreshold = elevated symptoms, but not enough to get an official diagnosis.
Also: the earlier the symptoms, the bigger the risks for adulthood, and also the more severe
the problems are.
TRAILS study (Ormel et al., 2018)
- 14 out of 19 adult outcomes were predicted by childhood and current psychiatric
disorders
- Effect of disorder depends on outcome
o Externalizing > health behaviors (e.g. substance abuse)
o Internalizing > psychological functioning (e.g. loneliness, suicidality, etc)
- Effect size: OR’s approximately 2
o With each disorder, the likelihood of negative adult outcome is doubled.
,Intervention spectrum
- Promotion:
o Target group = general population
o Goal = strengthening positive factors and reducing the risk at later problems
o Example: health campaigns
- Prevention (3 types):
o Universal prevention: targets complete population
Example depression: no effects were found (even some negative
effects, because children with no negative feelings had to think about
their negative feelings)
o Selective prevention: focus on high risk groups
o Indicated prevention: group with elevated/subclinical levels
Sometimes this comes close to treatment
For depression: this seems to work better
o Overall: the more focussed the prevention, the better the effects
- Treatment
o Case identification based on diagnostics
o Treatment = an array of nonmedical interventions to relieve psychological
distress, reduce maladaptive behaviour, or enhance adaptive functioning
through counselling, structured or unstructured interactions, training
programmes, or specific environmental changes (Weisz, 2004)
o There are a lot of different interventions
- Maintenance: making sure that people don’t go back to their problems after the
treatment
How effective are our treatments?
- “our results provide little evidence for the effectiveness of traditional child
psychotherapy” (Weiss, 1999)
o Traditional: how it’s usually done, the original kind of treatment
- “results provide support for the movement to revise traditional therapy techniques or
to replace and supplement them with techniques whose efficacy has been more clearly
demonstrated” (Weiss et al, 1999)
- As a scientist-practitioner, you can make a difference
Interventions
- Intervention criteria
o Goals
Example: parents can’t handle the parenting of their son with behaviour
problems. Possible goals are:
The clients are satisfied with the therapy and the therapist
o Important, but not the most important
The son doesn’t have behaviour problems anymore
o Wanted, but is it realistic? You do want reducing and
coping
The parents improve discipline practices and communication
skills with son
o Very important, but this alone won’t make the problem
go away.
, Often, there are more than one goals in a treatment.
Formulating goals: SMART (specific, measurable, Acceptable,
Realistic, Time-bound) and do it together with the client/parents
o Target group
Has to be specified
Not: children that are behind in their language development
But: children aged 2 to 6 years old which are behind 2 or more years in
their language development (passive and/or active)
o Program description
Methodology
Only 15% of the therapeutic successes are because of the
techniques. The other 85% are because of other factors
(extratherapeutic changes, placebo effect, therapeutic
relationship)
Non-specific factors:
o Good relationship between client and therapist
o Client’s motivation
o Structure of intervention
o Good fit between question for help and provided service
o Treatment integrity
o Education of therapist
o Organization/work conditions
Specific factors:
o Program that works for a specific target group
How does it work?
Mediators
for whom does it work?
Moderators
Support
Etiology and maintaining factors
Conceptual analysis of risk factors and protective factors
What are changeable factors (goals)?
Specific and nonspecific factors?
Conceptual analysis of problem
Executing demands: boundary conditions
Applicable and executable in clinical practice
Transferable
Limiting conditions are clear
- Psychotherapy with children (what makes it difficult?)
o Children are referred by others
Can lead to a lack of motivation
o Adults provide information
o Dependent on their environment
Often you need to work with the environment to help the kid
o Not as fixed as adults (so very important to help them early)
- Good interventions:
o Are goal directed
, o Improve psychological, social and/or cognitive development of the child
and/or reduce risks and developmental problems
o Are not only directed at the wellbeing of the child
- Ideally: a clearly specified and described intervention with a clear goal and target
group, which is targeted with a solid and theoretically supported methodology with
specific and nonspecific factors
- Reality: treatments are often not effective nor evidence-based
o No effect: waste of money, time and effort
o Latrogenic/harmful effects (dishion et al, 1999)
Weisz chapter 1 p3-10
The chapter begins with 4 cases
Sean: 9 years old, anxiety, often alone
Megan: 13 years old, depression, lack of motivation, angry
Kevin: 11 years old, distracted, impulsive, no concentration
Sal: 13 years old, conduct problems, often in trouble
Psychotherapy is old, but it is not clear how old exactly
- Socrates: questioning others in a way designed to prompt examination of their beliefs
and bring them closer to the truth
o Philosopher’s task was to deliver the truth that is already inside of someone
Similar to the view many modern therapists have of their role
o Psyche: mind, inner nature, …
Found by asking what a person thinks, instead of telling them what to
think
- Other Greeks have contributed to the evolution of psychotherapy as well
- Formal designation of psychotherapy as professional intervention: traced back about
100 years
- Freud’s psychoanalysis is (arguably) the foundation of (modern) psychotherapy
Research:
- Started later than psychotherapy itself
- Eysenck (1952): adult psychotherapy not effective
- Levitt & Eysenck: children with or without treatment improve the same amount
o Methodologically weak
- Studies have grown, meeting the standards of good research
Forms, scopes and costs of youth psychotherapy
- 551 named therapies
o Therapists often use a mix of therapies
- Two therapists might have different ideas about what treatment to use on a specific
case
Problems addressed in psychotherapy with children and adolescents
- Internalizing (sadness, fear, shyness, …)
- Externalizing (temper, anger, fighting, stealing, …)
- Western culture: more likely to be referred because of externalizing problems
Lecture 1 + Chapter 1 (p1-10) Weisz + article Weisz et
al (2017)
Dutch children are amongst the happiest children in the world. However, there are still
children in need. 15% of the children need any kind of help. 5% of the children need
specialized help. The goal of the transformation of the youthcare in The Netherlands was to
have less children in the specialized youthcare. This goal isn’t reached, the amount is more or
less the same.
The most common reason children are referred to care is behaviour problems. Please note that
this is the reason they are coming in to the youthcare, the reason for these problems can be
something else. The most common problem in children is anxiety. This is, however, not a
very visible problem and doesn’t always give a lot of problems for the environment. This
leads to the fact that children with anxiety problems are less likely to be referred to care.
It is important to intervene (early on), because:
- Mental health disorders among youths 10-24 years of age are the leading cause of
disease burden
o Interferes with social and academic functioning
- Mental health disorders have long-term effects on adult functioning (see figure)
This figure shows that kids who had disorders in childhood have more problems as adults than
kids who had nothing in their childhood. Also children who are in the subthreshold show
more problems in adulthood. (Big smokey mountain study; Copeland et al., 2015)
Subthreshold = elevated symptoms, but not enough to get an official diagnosis.
Also: the earlier the symptoms, the bigger the risks for adulthood, and also the more severe
the problems are.
TRAILS study (Ormel et al., 2018)
- 14 out of 19 adult outcomes were predicted by childhood and current psychiatric
disorders
- Effect of disorder depends on outcome
o Externalizing > health behaviors (e.g. substance abuse)
o Internalizing > psychological functioning (e.g. loneliness, suicidality, etc)
- Effect size: OR’s approximately 2
o With each disorder, the likelihood of negative adult outcome is doubled.
,Intervention spectrum
- Promotion:
o Target group = general population
o Goal = strengthening positive factors and reducing the risk at later problems
o Example: health campaigns
- Prevention (3 types):
o Universal prevention: targets complete population
Example depression: no effects were found (even some negative
effects, because children with no negative feelings had to think about
their negative feelings)
o Selective prevention: focus on high risk groups
o Indicated prevention: group with elevated/subclinical levels
Sometimes this comes close to treatment
For depression: this seems to work better
o Overall: the more focussed the prevention, the better the effects
- Treatment
o Case identification based on diagnostics
o Treatment = an array of nonmedical interventions to relieve psychological
distress, reduce maladaptive behaviour, or enhance adaptive functioning
through counselling, structured or unstructured interactions, training
programmes, or specific environmental changes (Weisz, 2004)
o There are a lot of different interventions
- Maintenance: making sure that people don’t go back to their problems after the
treatment
How effective are our treatments?
- “our results provide little evidence for the effectiveness of traditional child
psychotherapy” (Weiss, 1999)
o Traditional: how it’s usually done, the original kind of treatment
- “results provide support for the movement to revise traditional therapy techniques or
to replace and supplement them with techniques whose efficacy has been more clearly
demonstrated” (Weiss et al, 1999)
- As a scientist-practitioner, you can make a difference
Interventions
- Intervention criteria
o Goals
Example: parents can’t handle the parenting of their son with behaviour
problems. Possible goals are:
The clients are satisfied with the therapy and the therapist
o Important, but not the most important
The son doesn’t have behaviour problems anymore
o Wanted, but is it realistic? You do want reducing and
coping
The parents improve discipline practices and communication
skills with son
o Very important, but this alone won’t make the problem
go away.
, Often, there are more than one goals in a treatment.
Formulating goals: SMART (specific, measurable, Acceptable,
Realistic, Time-bound) and do it together with the client/parents
o Target group
Has to be specified
Not: children that are behind in their language development
But: children aged 2 to 6 years old which are behind 2 or more years in
their language development (passive and/or active)
o Program description
Methodology
Only 15% of the therapeutic successes are because of the
techniques. The other 85% are because of other factors
(extratherapeutic changes, placebo effect, therapeutic
relationship)
Non-specific factors:
o Good relationship between client and therapist
o Client’s motivation
o Structure of intervention
o Good fit between question for help and provided service
o Treatment integrity
o Education of therapist
o Organization/work conditions
Specific factors:
o Program that works for a specific target group
How does it work?
Mediators
for whom does it work?
Moderators
Support
Etiology and maintaining factors
Conceptual analysis of risk factors and protective factors
What are changeable factors (goals)?
Specific and nonspecific factors?
Conceptual analysis of problem
Executing demands: boundary conditions
Applicable and executable in clinical practice
Transferable
Limiting conditions are clear
- Psychotherapy with children (what makes it difficult?)
o Children are referred by others
Can lead to a lack of motivation
o Adults provide information
o Dependent on their environment
Often you need to work with the environment to help the kid
o Not as fixed as adults (so very important to help them early)
- Good interventions:
o Are goal directed
, o Improve psychological, social and/or cognitive development of the child
and/or reduce risks and developmental problems
o Are not only directed at the wellbeing of the child
- Ideally: a clearly specified and described intervention with a clear goal and target
group, which is targeted with a solid and theoretically supported methodology with
specific and nonspecific factors
- Reality: treatments are often not effective nor evidence-based
o No effect: waste of money, time and effort
o Latrogenic/harmful effects (dishion et al, 1999)
Weisz chapter 1 p3-10
The chapter begins with 4 cases
Sean: 9 years old, anxiety, often alone
Megan: 13 years old, depression, lack of motivation, angry
Kevin: 11 years old, distracted, impulsive, no concentration
Sal: 13 years old, conduct problems, often in trouble
Psychotherapy is old, but it is not clear how old exactly
- Socrates: questioning others in a way designed to prompt examination of their beliefs
and bring them closer to the truth
o Philosopher’s task was to deliver the truth that is already inside of someone
Similar to the view many modern therapists have of their role
o Psyche: mind, inner nature, …
Found by asking what a person thinks, instead of telling them what to
think
- Other Greeks have contributed to the evolution of psychotherapy as well
- Formal designation of psychotherapy as professional intervention: traced back about
100 years
- Freud’s psychoanalysis is (arguably) the foundation of (modern) psychotherapy
Research:
- Started later than psychotherapy itself
- Eysenck (1952): adult psychotherapy not effective
- Levitt & Eysenck: children with or without treatment improve the same amount
o Methodologically weak
- Studies have grown, meeting the standards of good research
Forms, scopes and costs of youth psychotherapy
- 551 named therapies
o Therapists often use a mix of therapies
- Two therapists might have different ideas about what treatment to use on a specific
case
Problems addressed in psychotherapy with children and adolescents
- Internalizing (sadness, fear, shyness, …)
- Externalizing (temper, anger, fighting, stealing, …)
- Western culture: more likely to be referred because of externalizing problems
