Research on Child and Adolescent Mental Health

training, multisystemic therapy, delinquency
prevention, and parent-child interaction treatment
for conduct problems.
In the past 5 years, there has been a concerted
effort by the clinical treatment research field to
move beyond small-scale efficacy trials to broaderbased
effectiveness studies (Hoagwood, Jensen,
Petti, & Burns, 1996). This emphasis on the
translation from efficacy to effectiveness has
resulted in an increase in studies that focus on
more heterogeneous populations, more "real-world"
settings (e.g., pediatricians’ offices), and a wider
range of outcomes with which to investigate the
applicability of the treatment under consideration.
Further, effectiveness studies are increasingly
attending to the use of treatment manuals to codify
procedures (Kazdin, 2000b), issues of treatment
fidelity (e.g., Schoenwald, Brown & Henggeler,
2000c), and assessment and maintenance of
therapeutic change (e.g., through an after-care
program that monitors children and families and
provides periodic treatment sessions, as needed, to
maintain treatment gains, prevent relapse, and
reduce the need for and use of additional services
following treatment (Kazdin, MH59029). Some
efforts are also underway to adapt, develop, and
test treatment approaches with specific cultural
groups (e.g., Rossello & Bernal, 1999).
More recent efforts at NIMH to encourage an
expanded treatment research agenda with a public
health focus have cautioned against the dichotomy
between efficacy and effectivenesstreatment
designs. In efforts to broaden the scope of clinical
research studies, the terms efficacy and
effectiveness have become buzzwords, resulting in
inconsistent use of terminology. As a result,
effectiveness research may mean many different
things. Rather than focusing on the strengths and
weaknesses of each type of design, the next frontier
of treatment research calls for new and innovative
methods, including mixed-modality approaches
(e.g., combined treatments—see Section B.6.
Combined Interventions and Services Effectiveness),
paradigms that include both experimental and
observational work, and hybrid treatment study
designs that combine the careful controls of efficacy
trials and the flexibility of effectiveness paradigms
(Miklowitz & Clarkin, 1999; Norquist, Lebowitz, &
Hyman, 1999).
The significant progress in this area indicates that
clinical psychosocial treatments have much to offer.
They offer the prospect of enhancing the quality of
children’s development and reducing the risk for
short- and long-term impairment. They also offer
the potential to provide alternatives or
complements to pharmacological interventions that
parents and children may view more positively. In a
related vein, psychosocial interventions may also
enhance the impact of pharmacological treatment.
As interdisciplinary research in child mental health
progresses, documented brain changes that occur in
children in response to psychosocial interventions
may inform our understanding of underlying
neurobiological mechanisms and biobehavioral
processes.
CROSSING THE BOUNDARIES
If the impressive advances in child and adolescent
psychosocial treatment research are to be
effectively applied and used in service settings,
such progress must be accompanied by a
systematic plan to guide treatment development,
future progress, and evaluation. The question of
“what treatment, by whom, is most effective for
this individual with that specific problem, under
which set of circumstances” may not be applicable
owing to the number of therapeutic techniques
under use, the number of child disorders, and the
wide range of factors that can influence treatment
outcome—all of which may vary depending on
when treatment is applied in the course of
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