Anxiety, depression, and behavioral problems are common among children and adolescents (youths) affecting more than 20% one or several times before adulthood. These problems are impairing, and linked to school absenteeism, school dropout, long term physical, social and educational problems, and increased risk of mental disorders in adulthood. The majority of youths with emotional and behavioural problems lack access to evidence-based treatments, indicating a need for systematic, large-scale implementation of effective psychological treatments and preventive interventions.The development of transdiagnostic and modular treatments has been suggested as a way to make evidence-based psychotherapies more available.This symposium presents the rationale and the preliminary results from two randomized controlled trials (RCTs), the Mind My Mind (MMM) and Back2School (B2S).Both investigates the effectiveness of a new modular Cognitive Behavioral Therapy (CBT) compared with treatment as usual for youths with symptoms of anxiety, depression, behavioral problems, and/or school absenteeism.The Mind My Mind (MMM) manual comprises evidence-based CBT, tailored to the child by dosing and sequencing of modules. The flexible application of modules is governed by the youth’s and parent’s description of a Top-problem and their scoring of the severity of the Top-problem. The primary outcome measure is the impact of problems in daily life in the domains of home, school and friendships. Back2School (B2S) is a modular trans-diagnostic CBT intervention for increasing school attendance and decreasing psychological problems among youths with problematic school absenteeism. It is based on a functional approach, and is supplemented by modules from the MMM manual.
Convenor: Daniel Bach Johnsen
Chair: Simon-Peter Neumer
Discussant: Mikael Thastum
Subject Track: Children and Young People
Presenters:
Pia Jeppesen (Paper 1)
Louise Puggaard (Paper 2)
Mikael Thastum (Paper 3)
Daniel Bach Johnsen (Paper 4)
PAPER 1:The Mind My Mind study: Lessons learned from the feasibility study and the ongoing main study.
Jeppesen, P1.; Neumer, S2.; Thastum, M.3; Puggaard, L.P.4; Rottbøll, A.S5; Wolf, R.T.6; Plessen, K.J.7; Bilenberg, N.8; Thomsen, P.H.9; Correll, C.U.10; Silverman, W11.
The Mind My Mind (MMM) program adapts current evidence-based treatment strategies for anxiety, depression and/or behavioral problems aiming at implementation in school children aged 6-16 years with such psychiatric problems. A feasibility randomized controlled trial (RCT) was conducted in four Danish municipalities (2015-2017). The children were randomized to the modular, cognitive and behavioral therapy (MMM) versus treatment as usual (TAU). Altogether, 264 children were screened for eligibility, 35 (13.3%) had only minor problems, 28 (10.6%) were lost during screening, 37 (14%) were excluded due to overly severe psychopathology, and 14 (5.3%) did not consent. Altogether, 150 children were randomized (3:1) to MMM (n=113, 52% boys) or TAU (n=37, 35% boys). The MMM group received an average of 11 (2-20) weekly sessions, 10 (8.8%) ended treatment prematurely, and 6 (5.3%) were referred to child and adolescent psychiatry. The ITT analyses of MMM versus TAU suggested benefits in the following domains: impact of problems on child’s daily life, anxiety, depressive symptoms, and functional impairments. Results were mixed for the Top-problem scores. An ongoing main study (RCT, N=412) employed new strategies for evaluation of child psychopathology, for linking the Top-problem to the treatment, and provides more principle-guided use of the modular MMM manual.
(ClinicalTrials.gov: NCT03448809)
Presenter: Pia Jeppesen Ph.D., senior researcher and specialist in child and adolescent psychiatry, Child and Adolescent Mental Health Centre, Mental Health Services of the Capital Region of Denmark.
AUTHORS PAPER 1
1. Pia Jeppesen, Ph.D., Associate Professor, Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Specialist in Child and Adolescent Psychiatry and Senior Researcher, Child and Adolescent Mental Health Centre, Mental Health Services of the Capital Region of Denmark.
2. Simon-Peter Neumer, Ph.D., Senior Researcher, Centre for Child and Adolescent Mental Health, Oslo, Norway.
3. Mikael Thastum, Ph.D., Professor, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark
4. Louise Berg Puggaard, Ph.D., Postdoc, Child and Adolescent Mental Health Centre, Mental Health Services of the Capital Region of Denmark.
5. Amanda Schulz Rottbøll, MSc in psychology, research assistant, Child and Adolescent Mental Health Centre, Mental Health Services of the Capital Region of Denmark.
6. Rasmus Trap Wolf, Ph.D. Fellow, Child and Adolescent Mental Health Centre, Mental Health Services of the Capital Region of Denmark¸ Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark
7. Kerstin Jessica Plessen, Ph.D., Professor and Head of Research, Child and Adolescent Mental Health Centre, Mental Health Services of the Capital Region of Denmark; Professor, Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
8. Niels Bilenberg, Ph.D., Professor and Head of Research, Department for Child and Adolescent Psychiatry, Psychiatry in Southern Denmark and University of Southern Denmark.
9. Per Hove Thomsen, Dr. Med., Professor and Director of the Research Center at the Psychiatric Hospital for Children and Adolescents, Aarhus University Hospital, Denmark.
10. Christoph U. Correll, Professor of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, New York, USA; Professor of Child and Adolescent Psychiatry, Charite Charité Universitätsmedizin, Berlin, Germany.
11. Silverman, Ph.D., Alfred A. Messer Professor of Child Psychiatry, Professor of Psychology and Director, Yale Child Study Center Anxiety and Mood Disorders Program, Yale University School of Medicine, USA.
PAPER 2: The Mind My Mind study: Measurement of treatment fidelity of a new trans-diagnostic and modular cognitive and behavioral treatment for school-aged children
Puggaard, L.P.1; Neumer, S.2; Rottbøll, A.S.3; Thastum, M.4; Correll, C.U.5; Silverman, W.6; Wolf, R.T.7; Plessen, K.J.8; Bilenberg, N.9; Thomsen, P.H.10; Jeppesen. P.11
The aim of this study is to develop and evaluate a video-observation-based fidelity measurement for Mind My Mind (MMM), which is a new trans-diagnostic and modular cognitive and behavioral treatment (CBT) for school-aged children with anxiety, depression, and/or behavioral problems. The study is conducted as an integrated part of the effectiveness randomized controlled trial (RCT) of MMM. The experimental group includes 206 children aged 6-16 years old, their parents and 26 therapists in the context of Educational Psychological Counselling in four Danish municipalities with a total of n=460 recordings of sessions. The MMM fidelity measurement is based on The Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS-CBT) that comprises six items covering: 1) CBT structure (homework planning and reviewing, structure and progress, and parental involvement), 2) process and relational skills (positive reinforcement, collaboration and flexibility), and 3) specific MMM CBT-interventions. Two items measure the global adherence and competence, and a final item measures the overall adaptation of the MMM program to the individual child’s needs. The challenges of measuring treatment fidelity in a transdiagnostic and modular CBT program will be discussed together with the presentation of preliminary inter-rater reliability results.
Presenter: Louise Berg Puggaard, Ph.D., Postdoc, Child and Adolescent Mental Health Centre, Mental Health Services of the Capital Region of Denmark.
AUTHORS PAPER 2
1. Louise Berg Puggaard, Ph.D., postdoc, Child and Adolescent Mental Health Centre, Mental Health Services of the Capital Region of Denmark.
2. Simon-Peter Neumer, Ph.D., Senior Researcher, Centre for Child and Adolescent Mental Health, Oslo, Norway.
3. Amanda Schulz Rottbøll, MSc in psychology, research assistant, Child and Adolescent Mental Health Centre, Mental Health Services of the Capital Region of Denmark.
4. Mikael Thastum, Ph.D., Professor, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark
5. Christoph U. Correll, Christoph U. Correll, Professor of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, New York, USA; Professor of Child and Adolescent Psychiatry, Charite Charité Universitätsmedizin, Berlin, Germany.
6. Wendy Silverman, Ph.D., Alfred A. Messer Professor of Child Psychiatry, Professor of Psychology and Director, Yale Child Study Center Anxiety and Mood Disorders Program, Yale University School of Medicine, USA.
7. Rasmus Trap Wolf, Ph.D. Fellow, Child and Adolescent Mental Health Centre, Mental Health Services of the Capital Region of Denmark¸ Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark
8. Kerstin Jessica Plessen, Ph.D., Professor and Head of Research, Child and Adolescent Mental Health Centre, Mental Health Services of the Capital Region of Denmark; Professor, Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
9. Niels Bilenberg, Ph.D., Professor and Head of Research, Department for Child and Adolescent Psychiatry, Psychiatry in Southern Denmark and University of Southern Denmark.
10. Per Hove Thomsen, Dr. Med., Professor and Director of the Research Center at the Psychiatric Hospital for Children and Adolescents, Aarhus University Hospital, Denmark.
11. Pia Jeppesen, Ph.D., Associate Professor, Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Specialist in Child and Adolescent Psychiatry and Senior Researcher, Child and Adolescent Mental Health Centre, Mental Health Services of the Capital Region of Denmark.
PAPER 3: Back2School: A feasibility study of a new modular cognitive behavioral intervention for youth with problematic school absenteeism
Thastum, M.1; Johnsen, D.B.2; Silverman, W.3; Heyne, D.4; Jeppesen, P.5; Jeppesen, J.L.6
Back2School (B2S) is a new program aiming to help young people with problematic school absenteeism (SA) back to regular school attendance, and consists of ten conjoint sessions with the young person and parents, four school meetings and a booster session. The manual comprises: 1) modules specifically addressing problems with school attendance, 2) modules addressing problems related to school attendance, such as anxiety, depression, or behavioral problems, derived from the Mind My Mind manual, 3) guidelines for conducting school meetings. In 2017, twenty-four young people with SA (more than 10% absence during the last three month) from primary and lower secondary schools in the Aarhus municipality (Denmark) were included in a feasibility study, together with their parents. Psychologists from the municipality conducted the treatment. The primary outcome measure was school attendance, while secondary outcome measures were anxiety, depression, and behavior problems. The evaluation of the program was based on qualitative feedback (participating families; schools; psychologists conducting B2S) and a preliminary evaluation of the efficacy of the program. The B2S manual was modified based on the results of the preliminary evaluation. It is now being tested against treatment as usual in a randomized controlled trial. The presentation focuses on outcome data and lessons learned from the feasibility study.
Presenter: Mikael Thastum, Ph.D., Professor, Department of Psychology, Aarhus University, Denmark.
AUTHORS PAPER 3:
1. Mikael Thastum, Ph.D., Professor, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark
2. Daniel Bach Johnsen, Ph.D. Fellow, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark
3. Wendy Silverman, Ph.D., Alfred A. Messer Professor of Child Psychiatry, Professor of Psychology and Director, Yale Child Study Center Anxiety and Mood Disorders Program, Yale University School of Medicine, USA.
4. David Heyne, Ph.D., Associate Professor in the Department of Psychology, Faculty of Social and Behavioural Sciences. University of Leiden.
5. Pia Jeppesen, Ph.D., Associate Professor, Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Specialist in Child and Adolescent Psychiatry and Senior Researcher, Child and Adolescent Mental Health Centre, Mental Health Services of the Capital Region of Denmark.
6. Johanne Jeppesen Lomholt, Ph.D., Assistant Professor, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark
PAPER 4: Back2School: Research design, rationale, and preliminary baseline data from a randomized controlled trial, treating school absenteeism.
Johnsen, D.B.1; Jeppesen, J.L.2 ; Silverman, W.3; Heyne, D.4; Jeppesen, P.5; Thastum, M.6
The Back2School (B2S) program is a modular cognitive behavioral therapy program aimed at helping youths with school absenteeism and their families. The study aims to investigate the efficacy of the B2S program in a randomized controlled trial (RCT) by comparing B2S against treatment as usual (TAU). The RCT runs from the summer of 2017 to 2019, and is conducted in collaboration between Aarhus University and Aarhus municipality. Youths in primary and lower secondary schools in Aarhus municipality (7-17 years), with more than 10% absence during the last three months of school, are eligible to participate in the study. Participants in the B2S condition (n=80) receive B2S treatment conducted by clinical psychologist from the municipality, while participants in the TAU condition (n=80) will receive standard help provided by the municipality. The primary outcome is change in school attendance, registered on a daily basis. Secondary outcome measures are anxiety, depression, behavioral problems, bullying, and school related self-efficacy. Based on the previous feasibility study, the B2S program is expected to significantly increase school attendance, and reduce symptoms of psychopathology and increase self-efficacy. The presentation focuses on the study design and descriptive baseline data from the ongoing RCT.
(ClinicalTrials.gov: NCT03459677)
Presenter: Daniel Bach Johnsen, Ph.D. Fellow, Department of Psychology, Aarhus University, Denmark.
AUTHORS PAPER 4:
1. Daniel Bach Johnsen, Ph.D. Fellow, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark
2. Johanne Jeppesen Lomholt, Ph.D., Assistant Professor, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark
3. Wendy Silverman, Ph.D., Alfred A. Messer Professor of Child Psychiatry, Professor of Psychology and Director, Yale Child Study Center Anxiety and Mood Disorders Program, Yale University School of Medicine, USA.
4. David Heyne, Ph.D., Associate Professor in the Department of Psychology, Faculty of Social and Behavioural Sciences. University of Leiden.
5. Pia Jeppesen, Ph.D., Associate Professor, Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Specialist in Child and Adolescent Psychiatry and Senior Researcher, Child and Adolescent Mental Health Centre, Mental Health Services of the Capital Region of Denmark.
6. Mikael Thastum, Ph.D., Professor, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark