1/2-Unified Treatment of Adolescent Emotional Disorders in Community Clinics

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 DESCRIPTION (provided by applicant): Emotional disorders, encompassing a range of anxiety and depressive disorders, are the most prevalent and comorbid psychiatric disorders in adolescence. They are chronic, impairing, costly, and share overarching commonalities. Unfortunately, evidence-based therapies (EBTs) exist for only single disorders or domains (e.g., depression), are rarely adopted by community mental health center (CMHC) clinicians, and effect sizes are modest (40-50% of youth are treatment non-responders). Thus, methods for improving outcomes for these youth, particularly in CMHCs are needed. This study tests the effectiveness of two novel interventions to address this need. The first intervention is a transdiagnostic treatment (the Unified Protocol for the Treatment of Emotional Disorders in Adolescents, UP-A), a promising new approach that uses a small number of common strategies to treat a broad range of emotional disorders. Transdiagnostic models align with NIH's initiative to advance the understanding and treatment of psychopathology using the Research Domain Criteria (RDoC). Importantly, this treatment approach is expected to improve client outcomes and have quicker uptake by CMHC clinicians because: (1) comorbidity is the rule, rather than the exception making this intervention more relevant for the patients seen in CMHCs, and (2) protocols cutting across diagnostic boundaries reduce training burden. The second intervention is a standardized monitoring and feedback system (MFS; Youth Outcomes Questionnaires, YOQ). This intervention can be built into the existing electronic medical records infrastructure of CMHCs and thus has appeal for its acceptability, ease of transport into clinical practice, and sustainability. Emerging data suggests that MFS alone improves outcomes relative to TAU but has not been adequately tested in youth. As an added value, this study also addresses a common threat to the internal validity of previous RCTs evaluating an EBT by isolating the confounding effects of increased measurement and feedback to clinicians. Finally, addressing a central aim of this RFA and making a unique and critical contribution to the treatment literature, this study will examine theoretically linked mechanisms (both patient and provider level) of treatment outcomes of both the UP-A and the YOQ. This collaborative R01 application (in response to RFA-MH-15-325) was prepared by Drs. Ehrenreich-May and Jensen-Doss at the University of Miami (Miami) and Dr. Ginsburg at The University of Connecticut School of Medicine (UConn; applications are identical). To test study aims, 222 adolescents (ages 12-17) with anxiety and/or depressive disorders will be recruited in CMHCs in Miami and Hartford (111 adolescents and 9 clinicians at each site). Both adolescents and clinicians will be randomized to one of three conditions: (1) TAU alone; (2) TAU plus YOQ, and (3) UP-A plus YOQ. Research assessments will occur at baseline, 8 weeks and 16 weeks after treatment initiation and a 3-month follow-up. If effective, these interventions have the potential to change clinical practice i CMHCs by equipping clinicians with more effective interventions that can be applied to a broad range of patients.