Child FIRST – Focus on Innovation and Redesign in Systems and Treatment
Below are selected key publications, organized by themes.
Mental Health Systems
Various independent lines of our research on treatments and systems have led to models for improving efficiency and quality in mental health systems. This has involved coordinating key strategies from dissemination and implementation science, quality improvement approaches, individualized care models, and evaluation and feedback systems. From 2000 to 2003, as these approaches were implemented and evaluated within the Hawaii Child and Adolescent Mental Health Division, the average system-wide rates of clinical improvement more than doubled in a budget-neutral scenario. In a similar effort from 2010 to 2013, more than 2,000 providers in Los Angeles County were trained in our flexible, multi-disorder approach, serving over 50,000 youths in the public system, with effect sizes greater than .70 independently gathered in subsample of those served.
Chorpita, B. F., & Daleiden, E. L. (2018). Coordinated strategic action: Aspiring to wisdom in mental health service systems. Clinical Psychology: Science and Practice, 25, 1-14.
Daleiden, E. L., Chorpita, B. F., Donkervoet, C. M., Arensdorf, A. A., & Brogan, M. (2006). Getting better at getting them better: Health outcomes and evidence-based practice within a system of care. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 749-756.
Southam-Gerow, M. A., Daleiden, E. L., Chorpita, B. F., Bae, C. Mitchell, C., Faye, M., & Alba, M. (2013). MAPping Los Angeles County: Taking an evidence-informed model of mental health care to scale. Journal of Clinical Child and Adolescent Psychology, 43, 190-200.
Our laboratory has spent more than 15 years articulating principles of modular treatment design and have built and tested multiple working examples. Such designs open the possibility for structured flexibility, efficient protocol revision, carefully controlled experimental manipulations, and collaborative multi-investigator protocol systems. In a recent multi-site randomized effectiveness trial for youths ages 7-13 with anxiety, depression, and/or conduct problems, modular treatment outperformed three high-fidelity evidence-based treatments as well as usual care on functional and clinical outcomes, diagnostic outcomes, service utilization outcomes, and therapist satisfaction. These findings were extended in a randomized effectiveness trial in urban Southern California, with a community sample of youth 5-15 with anxiety, depression, conduct problems, and traumatic stress.
Chorpita, B.F., Daleiden, E.L., Park, A.L., Ward, A. M., Levy, M. C., Cromley, T., Chiu, A. W., Letamendi, A. M., Tsai, H. H., & Krull, J. L. (2017). Child STEPs in California: A randomized effectiveness trial comparing modular treatment with community implemented treatment for youth with anxiety, depression, conduct problems, or traumatic stress. Journal of Consulting and Clinical Psychology, 85, 13-25.
Weisz, J.R., Chorpita, B.F., Palinkas, L.A., Schoenwald, S.K., Miranda, J., Bearman, S.K., Daleiden, E.L., Ugueto, A.M., Ho, A., Martin, J., Gray, J., Alleyne, A., Langer, D.A., Southam-Gerow, M.A., Gibbons, R.D., and the Research Network on Youth Mental Health. (2012). Testing standard and modular designs for psychotherapy with youth depression, anxiety, and conduct problems: A randomized effectiveness trial. Archives of General Psychiatry, 69, 274-282.
Technology and Clinical Reasoning
Our program has spent more than 20 years working with the design, implementation, and evaluation of measurement feedback systems and clinical decision supports. A particular innovation has involved designs for progress visualization in the context of practices delivered, allowing not only for outcomes feedback (e.g., is my case improving?) but also for integrative reasoning about practice-outcome relations (e.g., are practices used having an effect?). These models were implemented statewide in the Hawaii system, and were incorporated in two large randomized effectiveness trials.
Chorpita, B. F., Bernstein, A. D., Daleiden, E. L., & the Research Network on Youth Mental Health. (2008). Driving with roadmaps and dashboards: Using information resources to structure the decision models in service organizations. Administration and Policy in Mental Health and Mental Health Services Research, 35, 114-123.
Chorpita, B. F., Daleiden, E. L., & Bernstein, A. D. (2015). At the intersection of health information technology and decision support: measurement feedback systems…and beyond. Administration and Policy in Mental Health and Mental Health Services Research; DOI: 10.1007/s10488-015-0702-5
Daleiden, E., & Chorpita, B. F. (2005). From data to wisdom: Quality improvement strategies supporting large-scale implementation of evidence based services. Child and Adolescent Psychiatric Clinics of North America, 14, 329-349.
Seidman, E., Chorpita, B. F., Reay, B., Stelk, W., Kutash, K., Mullican, C., & Ringeisen, H. (2010). A framework for measurement feedback to improve decision-making in mental health. Administration and Policy in Mental Health and Mental Health Services Research, 37, 128-131.
Knowledge Management and Use of Evidence
Early knowledge management efforts to extract actionable information from the entire treatment outcome evidence base for youth led to the design of innovative analytic models for extracting and aggregating information from independent lines of treatment research. Central among these approaches is the Distillation and Matching Model, which involves a CHAID-based analytic approach applied simultaneously to information coded from treatment study and treatment protocol databases. The result yields information “trees” outlining unique clusters of practices associated with youth or context (e.g., treatment setting) features across the entire evidence base. This model led to a similar analytic innovation, Relevance Mapping, which simulates enrollment of youth within an actual service system in all published randomized trials, and through set minimization, can determine the smallest number of evidence based practices required to serve the largest number of youth in any service system, using any user-defined practice ontology and any user-defined standard of evidence. Our latest work involves investigation of Coordinated Knowledge Systems, which incorporate usable knowledge products into a defined decision and action cycle (e.g., planning, selecting, implementing, evaluating intervention strategies).
Bernstein, A. D., Chorpita, B. F., Daleiden, E. L., Ebesutani, C. E., & Rosenblatt, A. (2015). Building an evidence-informed service array: Considering evidence-based programs as well as their practice elements. Journal of Consulting and Clinical Psychology, 83, 1085-1096.
Bernstein, A., Chorpita, B., Rosenblatt, A., Becker, K., Daleiden, E., & Ebesutani, C. (2013). Fit of evidence-based treatment components to youths served by wraparound process: A relevance mapping analysis. Journal of Clinical Child & Adolescent Psychology, 44, 44-57.
Chorpita, B. F., Becker, K. D., & Daleiden, E. L. (2007). Understanding the common elements of evidence based practice: Misconceptions and clinical examples. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 647-652.
Chorpita, B. F., & Daleiden, E. L. (2009). Mapping evidence-based treatments for children and adolescents: Application of the distillation and matching model to 615 treatments from 322 randomized trials. Journal of Consulting and Clinical Psychology, 77, 566-579.
Chorpita, B. F., Daleiden, E., & Weisz, J. R. (2005). Identifying and selecting the common elements of evidence based interventions: A distillation and matching model. Mental Health Services Research, 7, 5-20.
Chorpita, B. F., Bernstein, A. D., & Daleiden, E. L. (2011). Empirically guided coordination of multiple evidence-based treatments: An illustration of relevance mapping in children’s mental health services. Journal of Consulting and Clinical Psychology, 79, 470-480.
Measurement of Anxiety and Depression in Youth
Early work from our lab in assessment and measurement of anxiety, along with the work of several others, contributed to refinements in the conceptualization and instrumentation for anxiety and depression in both children and adults. Most notably, this work involved articulating a detailed hierarchical model linking anxiety and depression and influenced key revisions to the Tripartite Model of anxiety and depression. One strand of this research led to the development of the Revised Child Anxiety and Depression Scales, now one of the most widely used measures for symptom dimensions of childhood anxiety disorders, which has since been translated into more than ten different languages.
Brown, T. A., Chorpita, B. F., & Barlow, D. H. (1998). Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. Journal of Abnormal Psychology, 107, 179-192.
Chorpita, B. F., & Daleiden, E. L. (2000). Properties of the Childhood Anxiety Sensitivity Index in children with anxiety disorders: Autonomic and non-autonomic factors. Behavior Therapy, 31, 327-350.
Chorpita, B. F., & Daleiden, E. L. (2002). Tripartite dimensions of emotion in a child clinical sample: Measurement strategies and implications for clinical utility. Journal of Consulting and Clinical Psychology, 70, 1150-1160.
Chorpita, B. F., Daleiden, E. L. Moffitt, C. E., Yim, L. M., & Umemoto L. A., (2000). Assessment of tripartite factors of emotion in children and adolescents I: Structural validity and normative data of an Affect and Arousal Scale. Journal of Psychopathology and Behavioral Assessment, 22, 141-160.
Chorpita, B. F., Yim, L. M., Moffitt, C. E., Umemoto L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: A Revised Child Anxiety and Depression Scale. Behaviour Research and Therapy, 38, 835-855.
Daleiden, E. L., Chorpita, B. F., & Lu, W. (2000). Assessment of tripartite factors of emotion in children and adolescents II: Construct validity and reliability of an Affect and Arousal Scale. Journal of Psychopathology and Behavioral Assessment, 22, 161-177.