Identifying Quality Indicators in Children's Mental Health Services: Identifying Evidence-Based Practice (EBP) Content Associated with Caregiver-Reported Child Mental Health Trajectories.

Despite efforts to characterize the psychotherapeutic strategies used in routine children's mental health services and develop pragmatic assessments of evidence-based practice (EBP) strategy delivery, research on the associations between EBP strategies and child outcomes is very limited. The Evidence-based Concordant Care Assessment (ECCA; Brookman-Frazee et al., 2021) is a measure designed to assess therapist delivery of evidence-based strategies in children's mental health services. Previous research on the predictive validity of the ECCA indicates that a subset of ECCA Technique strategies are associated with child mental health outcome trajectories across presenting problems. The current study extends analyses to identify ECCA Content strategies associated with caregiver-reported outcome trajectories for children with specific presenting problems, and for distinct age groups. Data were obtained from 1,380 sessions with 248 children being served by 76 therapists in two county systems. Child primary presenting problems included: depression (32%), externalizing problems (27%), anxiety (22%), trauma (14%), and other concerns (5%). Children were, on average, 11.8 years old (SD = 3.7). Therapists reported their delivery of EBP strategies at the session-level using the ECCA (Brookman-Frazee et al., 2021) which includes 25 Content strategies (e.g., Time-Out, Cognitive Restructuring). Caregivers reported symptoms on the Brief Problem Checklist (BPC; Chorpita et al., 2010) at baseline, weekly over two months of treatment, and again at four months. Multilevel models examined whether the frequency and/or the extensiveness of ECCA Content strategy use were associated with child outcome trajectories in subgroup analyses by primary presenting problem and age group. Fourteen ECCA Content strategies were significantly associated with decline in child symptoms for at least one presenting problem, and/or age group. Specifically, delivery of Cognitive Restructuring was significantly associated with symptom improvement in the full sample, and for subgoups including externalizing, trauma, and depression subgroups. Additional Content strategies were associated with outcomes for specific subgroups: Following the Child's Lead, Praise, and Differential Reinforcement for 8-12 year olds, Distracting & Redirecting for externalizing, depression, and 8-12 year olds; Timeout for depression; Behavioral Contracting for depression; Exposure for trauma; Relaxation for trauma, Youth Education Support/Activities for trauma; Assertiveness training for externalizing, and Safety Skills for trauma. The ECCA study is the first to demonstrate the associations between therapist reported use of individual EBP strategies and child outcomes within children's mental health services. The findings support the potential of scalable therapist reports of EBP content delivery as a pragmatic quality indicator in systems of care.