Evidence Based Practices: Clinical Tools and Interventions

A Culture of Accountability

Armstrong, R. & Mollenhauer, L. Toronto, Ontario, Canada: Children's Mental Health Ontario(June, 2006)

Youth & Drugs and Mental Health: A Resource for Professionals

Toronto, Canada: Centre for Addiction and Mental Health(2004)

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders

This revised practice parameter reviews the evidence from research and clinical experience and highlights significant advancements in the assessment and treatment of anxiety disorders since the previous parameter was published. It highlights the importance of early assessment and intervention, gathering information from various sources, assessment of comorbid disorders, and evaluation of severity and impairment. It presents evidence to support treatment with psychotherapy, medications, and a combination of interventions in a multimodal approach.

Washington, DC, USA: J. Am. Acad. Child Adolesc. Psychiatry(February, 2007)

Practice Parameters for the Assessment and Treatment of Children and Adolescents With Obsessive-compulsive Disorder

These practice parameters describe the assessment and treatment of obsessive-compulsive disorder based on a detailed literature review and expert consultation. Obsessive compulsive disorder is a disorder of heterogeneous origin characterized by intrusive thoughts or compulsive urges or behaviors that are distressing, time-consuming, or functionally impairing. In children and adolescents, the disorder often is accompanied by a wide range of comorbidity, including mood, anxiety, attention, and learning difficulties, and/or tic disorder. These parameters describe the relevant areas of assessment, especially symptomatology, onset and course, other associated psychopathology, and developmental, family, and medical history (including post-infectious onset or exacerbations). Only two modalities have been systematically assessed and empirically shown to ameliorate core symptoms: cognitive behavioral therapy (primarily exposure/response prevention) and serotonin re-uptake inhibitor medication. Data regarding the indications, efficacy, and implementation of these modalities are reviewed. Because of the frequent co-occurrence of other psychopathology and adaptive difficulties, additional educational, individual and family psychotherapeutic, and pharmacological interventions often are necessary. Treatment planning guidelines are provided.

Washington, DC, USA: American Academy of Child and Adolescent Psychiatry(1998)

CMHO's 'Arts-Based Mental Health Treatment' Project

• Pilot Project 1 - The Importance of Arts in a Day Treatment Program for Adolescents with Mental Health Problems
• Pilot Project 2 - Arts-based Treatment of Anishnaabe Children with Mental Health Problems
• Pilot Project 3 - The Impact of Art on Children's Clinical Treatment Outcomes

Toronto, Ontario, Canada: Children's Mental Health Ontario(2005)

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

This practice parameter describes the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) based on the current scientific evidence and clinical consensus of experts in the field. This parameter discusses the clinical evaluation for ADHD, comorbid conditions associated with ADHD, research on the etiology of the disorder, and psychopharmacological and psychosocial interventions for ADHD.

Washington/DC, USA: J. Am. Acad. Child Adolesc. Psychiatry(July, 2007)

Evidence Based Practices for Children and Adolescents with Autism Spectrum Disorders - Review of the Literature and Practice Guide

Perry, A. & Condillac, R. Toronto, Ontario, Canada: Children's Mental Health Ontario(2003)

Practice Parameters For The Assessment And Treatment Of Children, Adolescents, And Adults With Autism And Other Pervasive Developmental Disorders

Autism and the related pervasive developmental disorders (PDDs) are characterized by patterns of delay and deviance in the development of social, communicative, and cognitive skills, which arise in the first years of life. Although frequently associated with mental retardation these conditions are distinctive in terms of their course and treatment. These conditions have a wide range of syndrome expression and their management presents particular challenges for clinicians. Individuals with these conditions can present for clinical care at any point in development. The multiple developmental and behavioral problems associated with these conditions often require the care of multiple providers; coordination of services and advocacy for individuals and their families is important. Early, sustained intervention is indicated as is the use of various treatment modalities (e.g., pharmacotherapy, special education, speech-communication therapy, and behavior modification).

Washington, DC, USA: American Academy of Child and Adolescent Psychiatry(1999)

Assessment Toolkit for Bullying, Harassment, and Peer Relations at School

This toolkit is a companion document to the CPHA Safe School Study Research Report. It was designed for teachers, school administrators, and ministries of education to address some of the pressing needs identified in that Report. It provides a standard way to measure the nature and prevalence of school peer relationship problems, standards for quality programs, and a common set of tools to assess the impact of school-based programs. Also includes tips for students, parents, teachers and administrators.

Totten, Dr. M. et al. Ottawa, Ontario, Canada: Canadian Public Health Association(2004)

Cognitive Behavioural Approaches to Treating Children & Adolescents with Conduct Disorder

Baker, L. & Scarth, K. Toronto, Ontario, Canada: Children's Mental Health Ontario(2002)

Evidence Based Practices for the Treatment of Conduct Disorder in Children and Adolescents

This document was produced by CMHO's EBP Committee and identifies Evidence Based Practices for children and adolescents with Conduct Disorder. It will assist children's mental health professionals in their daily work with this challenging population.

Toronto, Ontario, Canada: Children's Mental Health Ontario(May 1, 2001)

Practice Parameters for the Assessment and Treatment of Children and Adolescents With Conduct Disorder

These practice parameters address the diagnosis, treatment, and prevention of conduct disorder (CD) in children and adolescents. A voluminous literature addresses the problem from a developmental, epidemiological, and criminological perspective. Properly designed treatment outcome studies of modern psychiatric modalities are rare. Ethnic issues are mentioned, but not fully addressed from a clinical perspective. Clinical features of conduct-disordered youth include predominance in males, low socioeconomic status, and familial aggregation. Important continuities to oppositional defiant disorder and antisocial personality disorder have been documented. Extensive comorbidity, especially with other externalizing disorders, depression, and substance abuse, has been documented and has significance for prognosis. Clinically significant subtypes exist according to age of onset, overt or covert conduct problems, and levels of restraint exhibited under stress. To be effective, treatment must be multimodal, address multiple foci, and continue over extensive periods of time. Early treatment and prevention appear more effective than later intervention.

Washington, DC, USA: J. Am. Acad. Child Adolesc. Psychiatry(October, 1997)

Early Childhood Mental Health Treatment - Literature Review and Practice Guide

Toronto, Ontario, Canada: Children's Mental Health Ontario(March, 2002)

Early Childhood Mental Health Treatment - Training Reference Guide

Toronto, Ontario, Canada: Children's Mental Health Ontario(Summer, 2002)

Knowledge Transfer and Implementation of Evidence-Based Practices in Children's Mental Health

A very important part of CMHO's work has been to ensure that a bridge is built between research and practice. This project is a collaborative effort funded by CMHO under the guidance of CMHO's EBPWG, the Community Health Systems Resource Group at the Hospital for Sick Children, and the National Implementation Research Network/Louis de la Parte Florida Mental Health Institute at the University of South Florida. Project objectives include: Review literature in knowledge transfer, organizational change, and implementation science; Survey leaders and practitioners in CMHCs across Ontario regarding their: utilization of research-based information; readiness for change; Interview experts in implementation science; Make recommendations for system of care improvements.

Toronto/Ontario, Canada: Children's Mental Health Ontario

Implementing Evidence-Based Practice in Children's Mental Health

Despite widespread acknowledgement that health practitioners need to be informed of the best currently available research evidence, implementing evidence-based practice (EBP) can be a challenge in real-world settings. This report focuses on implementing EBP in children’s mental health. The authors identified systematic reviews published between 1999-2003 on the topic of implementing EBP in a variety of health settings applicable to children’s mental health. To be included, systematic reviews had to meet a high standard involving a description of the search strategy and a list of criteria used to select original studies for detailed review. Reviews also had to include at least two randomized controlled trials.

Waddell, C., Godderis, R., Wong, W., & Garland, O. Vancouver, BC, Canada: Children's Mental Health Policy Research Program, University of British Columbia(November, 2005)

Doing More with What You Know: A Tool Kit on Knowledge Exchange

Ottawa, Ontario, Canada: The Provincial Centre of Excellence for Child and Youth Mental Health at CHEO(2006)

Implementation Research: A synthesis of the literature

Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., Wallace, F. Tampa, Florida, United States: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network(2005)

Evidence-Based Practice in Child and Adolescent Mental Health Services

Hoagwood, K. et al. Arlington, VA, USA: Psychiatric Services, 52:1179-1189(September, 2001)

Guide Lines for Adolescent Depression in Primary Care (GLAD-PC)

Jensen, P., Cheung, A., Levitt, A., & Zuckerbrot, R.

Treating Child and Adolescent Depression: A handbook for children

Baker, L. & Ashbourne, L. Toronto, Ontario, Canada: Children's Mental Health Ontario(2002)

Evidence Based Practices for the Treatment of Depression in Children and Adolescents

This document was produced by CMHO's EBP Committee and identifies Evidence Based Practices for children and adolescents with Depressive Disorder. It will assist children's mental health professionals in their daily work with this challenging population.

Toronto, Ontario, Canada: Children's Mental Health Ontario(May, 2001)

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders

This practice parameter describes the epidemiology, clinical picture, differential diagnosis, course, risk factors, and pharmacological and psychotherapy treatments of children and adolescents with major depressive or dysthymic disorders. Side effects of the antidepressants, particularly the risk of suicidal ideation and behaviors are discussed. Recommendations regarding the assessment and the acute, continuation, and maintenance treatment of these disorders are based on the existent scientific evidence as well as the current clinical practice.

Washington, DC, USA: J. Am. Acad. Child Adolesc. Psychiatry(November, 2007)

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder

This practice parameter reviews the literature on the assessment and treatment of children and adolescents with bipolar disorder. The parameter focuses primarily on bipolar 1 disorder because that is the type most often studied in juveniles. The presentation of bipolar disorder in youth, especially children, is often considered atypical compared with that of the classic adult disorder, which is characterized by distinct phases of mania and depression. Children who receive a diagnosis of bipolar disorder in community settings typically present with rapid fluctuations in mood and behavior, often associated with comorbid attention-deficit/hyperactivity disorder and disruptive behavior disorders. Thus, at this time it is not clear whether the atypical forms of juvenile mania and the classic adult form of the disorder represent the same illness. The question of diagnostic continuity has important treatment and prognostic implications. Although more controlled trials are needed, mood stabilizers and atypical antipsychotic agents are generally considered the first line of treatment. Although patients may respond to monotherapy, combination pharmacotherapy is necessary for some youth. Behavioral and psychosocial therapies are also generally indicated for juvenile mania to address disruptive behavior problems and the impact of the illness on family and community functioning.

Washington, DC, USA: J. Am. Acad. Child Adolesc. Psychiatry(January, 2007)

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is a common clinical problem in children and adolescents. Oppositionality and associated types of aggressive behavior are among the most common referral problems in child psychiatry. Grouped among the disruptive behavior disorders, ODD is frequently comorbid with other psychiatric conditions and often precedes the development of conduct disorder (CD), substance abuse, and severely delinquent behavior. Youth with ODD may also have specific CD behaviors, such as aggression. Although compared with CD there exists a smaller and less sophisticated empirical database for ODD, this parameter draws upon the existing ODD and CD literature to make recommendations regarding diagnosis and treatment of ODD. The etiology of ODD is complex and its development is based on a cumulative risk/protective factor model that combines biological, psychological, and social factors. Recommended treatment is multimodal and extensive, involving individual and family psychotherapeutic approaches, medication, and sociotherapy. Methodologically sound controlled clinical trials are lacking.

Washington, DC, USA: J. Am. Acad. Child Adolesc. Psychiatry(January, 2007)

Practice Parameters for the Assessment and Treatment of Children and Adolescents With Posttraumatic Stress Disorder

Since the introduction of posttraumatic stress disorder (PTSD) as a diagnostic category in DSM-III (American Psychiatric Association, 1980), there has been a growing awareness that children and adolescents as well as adults can experience this disorder. Because it is a relatively new diagnosis, because the diagnostic criteria have changed with each DSM revision since 1980, and particularly because developmental factors may significantly impact on the clinical presentation of this disorder, practice parameters can be of value in assisting clinicians in the diagnosis and treatment of childhood PTSD, and as a result, also be of value to the children and families of children who develop this disorder.

Washington/DC, USA: American Academy of Child and Adolescent Psychiatry(1998)

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Schizophrenia

This practice parameter reviews the literature on the assessment and treatment of children and adolescents with schizophrenia. Recommendations are based on the limited research available, the adult literature, and clinical experience. Earlyonset schizophrenia is diagnosed using the same criteria as in adults, and it appears to be continuous with the adult form of the disorder. Noted characteristics of youth with schizophrenia include predominance in males, high rates of premorbid abnormalities, and often poor outcome. Differential diagnosis includes psychotic mood disorders, developmental disorders, organic conditions, and nonpsychotic emotional/behavioral disorders. Treatment strategies incorporate antipsychotic medications with psychoeducational, psychotherapeutic, and social and educational support programs. The advent of atypical antipsychotic agents has enhanced the potential for effective treatment.

Washington/DC, USA: J. Am. Acad. Child Adolesc. Psychiatry(July, 2001)

Aboriginal Youth: A Manual of Promising Suicide Prevention Strategies

Jodoin, N. & White, J Calgary, Alberta, Canada: Centre for Suicide Prevention, Suicide Prevention Training Programs(2003, Revised 2004)

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Suicidal Behavior

These guidelines review what is known about the epidemiology, causes, management, and prevention of suicide and attempted suicide in young people. Detailed guidelines are provided concerning the assessment and emergency management of the children and adolescents who present with suicidal behavior. The guidelines also present suggestions on how the clinician may interface with the community. Crisis hotlines, method restriction, educational programs, and screening/ case-finding suicide prevention strategies are examined, and the clinician is advised on media counseling. Intervention in the community after a suicide, minimization of suicide contagion or imitation, and the training of primary care physicians and other gatekeepers to recognize and refer the potentially suicidal child and adolescent are discussed.

Washington/DC, USA: J. Am. Acad. Child Adolesc. Psychiatry(July, 2001)