Department of Psychology, Harvard University, Cambridge, Massachusetts 02138; email:
Annu Rev Clin Psychol. 2015;11:139-63. doi: 10.1146/annurev-clinpsy-032814-112820.
Most youth psychotherapy research involves conditions quite unlike the clinical practice it is designed to strengthen. Most studies have not tested interventions with clinically referred youths and practicing clinicians in clinical care settings, nor have they tested whether new treatments produce better outcomes than usual practice. Limited exposure to real-world conditions and questions may partially explain why empirically supported treatments show such modest effects when tested under more representative conditions, against usual care. Our deployment-focused model calls for intervention development and testing with the kinds of participants (e.g., clients and clinicians) and in the contexts (e.g., clinics) for which the interventions are ultimately intended, and for randomized comparisons to usual clinical care. Research with the Child STEPs (system and treatment enhancement projects) treatment approach illustrates the methods and potential benefits of the deployment-focused model. Findings supporting Child STEPs are but one part of a rich research matrix needed to shrink the gap between intervention research and clinical practice.
大多数青年心理治疗研究涉及的情况与旨在加强的临床实践大不相同。大多数研究并未在临床护理环境中对接受临床转诊的青少年和执业临床医生进行干预措施测试，也未测试新的治疗方法是否比常规治疗产生更好的结果。对现实情况和问题的了解有限可能部分解释了为什么在更具代表性的条件下，针对常规护理进行测试时，经验支持的治疗方法效果如此温和。我们以部署为重点的模型要求针对最终预期的参与者（例如，客户和临床医生）和环境（例如，诊所）进行干预措施的开发和测试，并与常规临床护理进行随机比较。使用儿童 STEPs（系统和治疗增强项目）治疗方法进行的研究说明了以部署为重点的模型的方法和潜在好处。支持儿童 STEPs 的发现只是缩小干预研究与临床实践之间差距所需的丰富研究矩阵的一部分。
