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<p>Schools, followed by outpatient mental health clinics, are the most common setting for youth mental health services. Whereas outpatient mental health clinics are designed for mental health care, schools are not. Therefore, it is important to understand how care provided in schools compares to care provided in traditional outpatient clinics. We sought to find out which setting (schools or clinics) allocated the greatest percentage of session time to, and demonstrated higher competence in, implementing evidence-based practices for anxiety, depression, and conduct problems, after controlling for youth symptom presentation at treatment onset. We used observational coding of treatment-as-usual sessions in randomized controlled trials with 110 youths, treated by 44 clinicians, in 5 school districts and 3 outpatient clinics. Clinic-based providers spent a significantly greater percentage of session time implementing anxiety, depression, and conduct evidence-based practices than school-based providers (36.04% vs. 14.84%, <i>p</i> &lt; 0.001). In fact, setting, rather than symptom severity at the start of therapy, was the primary predictor for how much of session time was spent implementing anxiety, depression, and conduct evidence-based practices. However, setting did not predict the competence with which these practices were delivered. Providers in clinics, compared to those in schools, devoted more than twice as much time in sessions to delivering evidence-based practices, but when such practices were delivered, providers in the two settings showed similar levels of competence. Future research may investigate what factors account for setting differences in the frequency with which clinician competencies are applied during sessions.</p>

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Adherence and Competence in Delivering Evidence-Based Practices to Children and Adolescents Across Clinic- and School-Based Clinicians

  • 期刊论文

  • 发表日期：

    2026年4月22日

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  • Malena A. Nygaard,
  • Julie M. Petersen,
  • Amanda A. Bowling,
  • Nichole Baker,
  • Abby Bailin Kirshner,
  • Cal Mahoney,
  • Sydney C. Kwaku,
  • John R. Weisz,
  • Sarah Kate Bearman

摘要

Schools, followed by outpatient mental health clinics, are the most common setting for youth mental health services. Whereas outpatient mental health clinics are designed for mental health care, schools are not. Therefore, it is important to understand how care provided in schools compares to care provided in traditional outpatient clinics. We sought to find out which setting (schools or clinics) allocated the greatest percentage of session time to, and demonstrated higher competence in, implementing evidence-based practices for anxiety, depression, and conduct problems, after controlling for youth symptom presentation at treatment onset. We used observational coding of treatment-as-usual sessions in randomized controlled trials with 110 youths, treated by 44 clinicians, in 5 school districts and 3 outpatient clinics. Clinic-based providers spent a significantly greater percentage of session time implementing anxiety, depression, and conduct evidence-based practices than school-based providers (36.04% vs. 14.84%, p < 0.001). In fact, setting, rather than symptom severity at the start of therapy, was the primary predictor for how much of session time was spent implementing anxiety, depression, and conduct evidence-based practices. However, setting did not predict the competence with which these practices were delivered. Providers in clinics, compared to those in schools, devoted more than twice as much time in sessions to delivering evidence-based practices, but when such practices were delivered, providers in the two settings showed similar levels of competence. Future research may investigate what factors account for setting differences in the frequency with which clinician competencies are applied during sessions.