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Summary InterventionLecture 1: The why, what and which
428.000 adolescents are in the mental youth care in the Netherlands. That is almost 1 out of
10.
Adolescents with mental care, 2017
Mental health care to demographic aspects of the younger, 2017
Children in need
Expected percentage of youth with severe problems, NJI 2013.
Why is it important to intervene (early on)?
Mental health disorders among youths 10 to 24 years of age the leading cause of
disease burden (Harhay & King, 2012)
o Interferes with social and academic functioning
Long-term effects on adult functioning (Great Smoky Mountains Study: Copeland et
al., 2015; TRAILS study: Ormel et al., 2018).
Great smoky mountains study
Adult functional outcomes of common childhood psychiatric problems. A prospective,
longitudinal study.
,Associations between adult outcomes and childhood diagnostic groups the likelihood of
having either any outcome or more than 1 outcome based on childhood psychiatric status.
Error bars indicate standard error.
TRAILS study
14 out of 19 adults 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, mental
health care)
Effect size: OR's approximately 2
o With each disorder likelihood of negative adult outcome is doubled
So in fact, there is good evidence to intervene early on.
Intervention spectrum
Promotion
Target group; general population
Goal; strengthening positive factors and reducing the risk at later problems
Universal prevention
o (Part of) general population
Op volle kracht in school curriculum (Tak et al.)
No positive effects on this prevention program for regular teens to
decrease depression symptoms have.
Selective prevention
, o High risk groups
Op volle kracht in high-risk neighborhoods (Kindt et al. )
No positive effects for high-risk neighborhoods kids to decrease
depression symptoms, but a positive effect if their parent had
psychological problems
Indicated prevention
o Group with elevated/subclinical levels (Poppelaars et al.; Wijnhoven et al.)
The more targeted the prevention groups are, the more effect they have.
Treatment
Case identification
o Based on diagnostics
Treatment
o '… an array of nonmedical interventions to relieve psychological distress,
reduce maladaptive behavior, or enhance adaptive functioning through
counseling, structured or unstructured interactions, training programs, or
specific environmental changes' (Weisz, 2004; p.5)
How are we doing with are clinical care?
Not so great.
Research shows that the clinical care that we provide, kids are not doing much better
than thy didn't receive this care.
'… our results provide little evidence of effectiveness of traditional child
psychotherapy..' (Weisz, et al., 1999; p.91)
'.. 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 (Weisz, et al., 1999;p.93)
What makes it different from intervening with children and adults? Psychotherapy with
children
There are always parents involved
Other people/adults provide information about the child
Children are referred by others and they do or do not recognize the problem
Dependent on their environment
Interventions
Are goal directed
Improve psychological, social and/or cognitive development of the child and/or reduce
risk and developmental problems (Ince & Van den Berg, 2010)
Are not only directed at the wellbeing of the child (Yirmiya, 2010)
Really dependent on the theoretical frame
Intervention criteria
Goal
Target group
Program description
o Methodology
o Support
o Executing demands
o Practicalities
, Goal intervention
Example; parents can't handle the parenting of their son with behavior problems. A good
result would be; the parent improve discipline practices and communication skills with son.
Formulating goals
What's wrong with..?
o Support the child
o Stimulate language development
o Cope with trauma
Formulating good goals
According to SMART criteria
o S = specific, significant, simple, sustainable
o M = measurable, meaningful, manageable
o A = achievable, agreed, attainable
o R = realistic, result-based, reasonable
o T = time-bound, timed, time-specific
So rather than: support the child, better say; after a 3-month intervention the child should be
able to cope with his anxieties.
Target group define the target group specifically
What's wrong with children that are behind in their language development? Better children
aged 2 to 6 years old which are behind 2 or more years in their language development
(passive and/or active).
Program description; Methodology
Extratherapeutische veranderingen; personal changes in the clients life.
Methodology
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 (presenting problem) and provided service
o Treatment integrity
o Education of therapist
o Organization/work conditions (workload, caseload, supervision)
Specific factors
o Program that works for a specific target group
How does it work?
Mediators
From whom does it work?
Moderators
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