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Program Profile: Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH-ADTC)

Evidence Rating: Promising - More than one study Promising - More than one study

Date: This profile was posted on November 07, 2018

Program Summary

The program is a coordinated, component-based approach that allows for real-time adaptation of treatment to address the complex needs of clinically-referred, comorbid youths, whose problems and treatment needs can shift during treatment. The program is rated Promising. In examining MATCH-ADTC to usual care, there were mixed results across three evaluations, but there were statistically significant reductions in internalizing and externalizing problems, functioning, and severity of problems.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals
The Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH-ADTC) is a coordinated, component-based approach that uses theory, performance feedback, and clinical reasoning to guide real-time adaptation of treatment to address the complex needs of clinically referred, comorbid youths, whose problems and treatment needs can shift during treatment. The MATCH-ADTC intervention emphasizes building youths’ skills and capacities, with the goal of improving their abilities to manage symptoms and enhance functioning.

Target Population
MATCH-ADTC targets youths with primary clinical concerns involving diagnoses or clinical elevations of anxiety, depression, trauma, or disruptive conduct disorders.

Program Components
MATCH-ADTC is a collection of 33 therapeutic components, which are designed for use in day-to-day practice. The program was developed by conducting a large-scale literature search for studies that examined treatment protocols for clinically referred youth (such as cognitive-behavioral therapy). The literature review led to the identification of the 33 discrete therapy practices that were the most common across the identified empirical studies and focused on the four clinical areas of interest (i.e., anxiety, depression, trauma, and conduct disorders). The treatment procedures from these therapy practices were developed into freestanding modules. The modules then formed a “menu” of options for therapists to select from. A decision flowchart helps to guide therapists’ selection and sequencing of the modules, all dependent on the needs of the youth (Weisz et al. 2012). MATCH-ADTC addresses not only anxiety, depression, trauma-related issues, or conduct problems, but also related issues or challenges that may emerge during therapy.

The therapist begins treatment by focusing on the initial problem area defined as most important based on standardized measures and as reported by the patient. The MATCH-ADTC intervention uses algorithms that help therapists to make real-time changes to the treatment modules if outcome measures (which are gathered each week) indicate youths are having a poor response to treatment. For example, MATCH-ADTC therapists can use procedures from the modules earlier than indicated (by jumping ahead in the sessions) or they could omit procedures that do not seem well-suited for the youth. MATCH-ADTC therapists can also change procedures to address multiple problem areas within a single treatment session or treatment episode; for example, for a youth whose primary diagnosis is depression, a therapist could concurrently address disruptive behavior issues, if those symptoms impede the use of depression modules. Therapists return to depression treatment when the interference is resolved.

Key Personnel
MATCH-ADTC is administered by trained therapists, including social workers, psychologists, and licensed mental health counselors.

Evaluation Outcomes

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Study 1
Youth-Reported Problems of Greatest Clinical Concern
Weisz and colleagues (2012) found that, from baseline to posttreatment, there was no statistically significant between-group difference on youth-reported severity of top problems.

Caregiver-Reported Problems of Greatest Clinical Concern
From baseline to posttreatment, caregivers of youths in the Modular Approach to Therapy for Children (MATCH-ADTC) treatment group reported a greater rate of decrease in severity of top problems, compared with caregivers of youths in the community-implemented treatment control group. This difference was statistically significant.

Study 2
Youth-Reported Internalizing Problems
Chorpita and colleagues (2013) found that, from baseline to 24-month follow up, youths in the MATCH-ADTC treatment group showed faster reduction in self-reported internalizing problems, compared with youths in the usual care control group. This difference was statistically significant.

Caregiver-Reported Internalizing Problems
There was no statistically significant between-group difference on caregiver-reported internalizing problems.

Youth-Reported Externalizing Problems
There was no statistically significant between-group difference on youths’ self-reported externalizing problems.

Caregiver-Reported Externalizing Problems
From baseline to 24-month follow up, caregivers of youths in the MATCH-ADTC treatment group reported a faster reduction in externalizing problems, compared with caregivers of youths in the usual care control group. This difference was statistically significant.

Youth Functional Impairment in Interpersonal Relations, School, and Self-Care
There was no statistically significant between-group difference on caregivers’ ratings of youths’ life functioning.

Study 3
Caregiver-Reported Externalizing Problems
Chorpita and colleagues (2017) found that, from baseline to posttreatment, youths in the MATCH-ADTC treatment group showed greater rate of decrease in externalizing problems, compared with youths in the community-implemented treatment control group. This difference was statistically significant.

Youth-Reported Externalizing Problems
From baseline to posttreatment, youths in the modular treatment group showed a greater rate of decrease in externalizing problems, compared with youths in the community-implemented treatment control group. This difference was statistically significant.

Caregiver- and Youth-Reported Internalizing Problems
From baseline to posttreatment, youths in the MATCH-ADTC treatment group showed a greater rate of decrease in internalizing problems, compared with youths in the community-implemented treatment control group. This difference was statistically significant.

Caregiver-Reported Problems of Greatest Clinical Concern
From baseline to posttreatment, caregivers of youths in the MATCH-ADTC treatment group reported a greater rate of decrease in severity of top problems, compared with caregivers of youths in the community-implemented treatment control group. This difference was statistically significant.

Youth-Reported Problems of Greatest Clinical Concern
From baseline to posttreatment, youths in the modular treatment group reported a greater rate of decrease in severity of top problems, compared with youths in the community-implemented treatment control group. This difference was statistically significant.
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Evaluation Methodology

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Study 1
Weisz and colleagues (2012) used a cluster randomization design to assign 84 therapists, from 10 different outpatient community- and school-based settings in Massachusetts and Hawaii, to one of three study conditions: 1) standard manualized treatment condition; 2) modular condition (MATCH-ADTC); and 3) usual care. The CrimeSolutions.gov review of this study focused on the comparisons between the modular condition and usual care (see Other Information for further details). Therapists were assigned using blocked randomization stratified by their educational level (doctoral versus master’s degree). Participating youths had all sought outpatient care and had primary clinical concerns involving either a diagnosis of anxiety, depression, or disruptive conduct disorders, or they showed clinical elevations in any of these areas.

Clinicians randomized to the modular treatment group used a collection of 31 modules from MATCH-ADTC that corresponded to three manualized treatment protocols: Coping Cat for anxiety, Primary and Secondary Control Enhancement Training (PACET) for depression, and Defiant Children for disruptive conduct and noncompliant behavior, in addition to guiding algorithms for their use. Clinicians randomized to the usual care group used their normal treatment procedures.

The full sample consisted of 174 youths ages 7 to 13 years old, with a mean age of 10.6 years. There were 69 youths in the standard condition, 70 youths in the modular condition, and 64 youths in the usual care condition. Demographic information was provided for the overall study sample, although the comparison of interest for this CrimeSolutions.gov review is the modular condition compared with the usual care condition. The majority of the participants were boys (70 percent) and white (45 percent) or multiethnic (32 percent). The remaining sample was African American (9 percent), Latino/Latina (6 percent), Asian American/Pacific Islander (4 percent), and other (2 percent). The most common diagnoses were conduct-related disorder (42.5 percent), anxiety disorder (29.3 percent), and mood disorder (16.7 percent).

Child and caregiver versions of the Top Problems Assessment were used to assess the severity of the top three problems of greatest clinical concern to youths and their caregivers. Assessors blind to study condition conducted assessments at baseline and post-treatment, and at several time points in between. To measure the effect of the intervention on the problems of greatest clinical concern, mixed effects regression models were estimated.

Study 2
Chorpita and colleagues (2013) used the data gathered as part of the randomized controlled trial from Weisz and colleagues (2012), described above. The 2013 study extends the original 2012 study by examining different outcome measures.

For the outcomes of interest, the Child Behavior Checklist and Youth Self-Report were used for caregivers and youths, respectively, to assess the youths’ emotional and behavioral symptoms (internalizing and externalizing problems). Caregivers also reported on the youths’ functional impairment across three domains: interpersonal relations, school, and self-care, using the Brief Impairment Scale. Assessors blind to study condition conducted assessments at baseline, 24 months following study enrollment, and at several time points in between. To measure the effect of the MATCH-ADTC intervention on internalizing problems, externalizing problems, and functioning, mixed effects regression models were estimated. There were no subgroup analyses.

Study 3
Chorpita and colleagues (2017) used a cluster randomization design with 50 therapists from three different community agencies in low-income urban settings in Los Angeles County and San Bernardino County. Therapists were assigned to either the MATCH-ADTC treatment group or the community-implemented treatment control group using blocked randomization. Participating youths were referred to their local public mental health agency and had primary clinical concerns involving anxiety, depression, disruptive behavior, or traumatic stress.

Clinicians randomized to the modular treatment group used MATCH-ADTC. Clinicians randomized to the community-implemented control condition used treatment procedures as they normally would in the context of county-mandated use of evidence-based treatments.

This 2017 study differed from the 2012 and 2013 studies (described above) in that it included use of all 33 modules within MATCH-ADTC in the analysis of effectiveness. The earlier studies did not include a comparison condition for a manualized trauma treatment; therefore, the two trauma-specific modules of MATCH-ADTC were omitted.

The analytic sample included 138 youths ages 5 to 15 years old, with a mean age of 9.3 years. Of those, 78 youths were assigned to the intervention group, and 60 were assigned to the community-implemented treatment control group. Just over half (55.1 percent) were boys. The majority of the sample was Latino/a (78.3 percent), followed by 10.1 percent African American, 8.0 percent multiethnic, and 3.6 percent white. The most common focus of primary concern was conduct/disruptive behavior (43.5 percent), followed by depression (28.3 percent), and anxiety (27.5 percent).

Child and caregiver versions of the Brief Problem Checklist were used to assess internalizing and externalizing problems. Child and caregiver versions of the Top Problems Assessment were used to assess the severity of the problems of greatest clinical concern to youths and their caregivers. Assessors blind to study condition conducted assessments at baseline and posttreatment, and on a weekly basis during the course of the treatment. To measure the effect of the intervention on internalizing problems, externalizing problems, and the problems of greatest clinical concern, mixed effects regression models were estimated. There were no subgroup analyses.
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Cost

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There are two organizations that provide training, consulting, and credentialing services for the Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH-ADTC) program: PracticeWise, LLC and Judge Baker Children’s Center. To contact either organization for information about training options and pricing, please see the contact information section.
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Implementation Information

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Please see the Costs section above for information on training, consulting, and credentialing services. Materials have been translated for Spanish-speaking caregivers.
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Other Information

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Data from the project was collected from the Child System and Treatment Enhancement Projects (Child STEPs) initiative, launched in 2003 by the Research Network on Youth Mental Health Care. The initiative was funded by the John T. and Catherine D. MacArthur Foundation to improve mental health care options for children by gathering information on the clinical settings where children are treated, designing new methods to implement evidence-based practices, and developing tools to help clinicians make sound decisions while treating children. CrimeSolutions.gov does not assess results from comparative effectiveness research (CER). For a definition of CER, please see the Glossary: https://www.crimesolutions.gov/GlossaryDetails.aspx?ID=62. Thus, in the studies by Weisz and colleagues (2012) and Chorpita and colleagues (2013), the CrimeSolutions.gov review focused only on the comparisons between the Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH-ADTC) condition and the usual care condition and did not consider the comparisons between MATCH-ADTC and the standard manualized treatment condition.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Weisz, John, Bruce Chorpita, Lawrence Palinkas, Sonja Schoenwald, Jeanne Miranda, Sarah Bearman, Eric Daleiden, Ana Ugueto, Anya Ho, Jacqueline Martin, Jane Gray, Alisha Alleyne, David Langer, Michael Southam-Gerow, Robert Gibbons, and the Research Network on Youth Mental Health. 2012. “Testing Standard and Modular Designs for Psychotherapy Treating Depression, Anxiety, and Conduct Problems in Youth.” Archives of General Psychiatry 69:274–82.

Study 2
Chorpita, Bruce, John Weisz, Eric Daleiden, Sonja Schoenwald, Lawrence Palinkas, Jeanne Miranda, Charmaine Higa-McMillan, Brad Nakamura, A. Aukahi Austin, Cameo Borntrager, Alyssa Ward, Karen Wells, Robert Gibbons, and Research Network on Youth Mental Health. 2013. “Long-Term Outcomes for the Child STEPs Randomized Effectiveness Trial: A Comparison of Modular and Standard Treatment Designs With Usual Care.” Journal of Consulting and Clinical Psychology 81:999–1009.

Study 3
Chorpita, Bruce, Eric Daleiden, Alayna Park, Alyssa Ward, Michelle Levy, Taya Cromley, Angela Chiu, Andrea Letamendi, Katherine Tsai, and Jennifer Krull. 2017. “Child STEPs in California: A Cluster Randomized Effectiveness Trial Comparing Modular Treatment With Community Implemented Treatment for Youth With Anxiety, Depression, Conduct Problems, or Traumatic Stress.” Journal of Consulting and Clinical Psychology 85:13–25.
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Additional References

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These sources were used in the development of the program profile:

Schoenwald, Sonja, Kelly Kelleher, John Weisz, and the Research Network on Youth Mental Health. 2008. “Building Bridges to Evidence-based Practice: The MacArthur Foundation Child System and Treatment Enhancement Projects (Child STEPs).” Administration and Policy in Mental Health 35:66–72.
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Program Snapshot

Age: 5 - 15

Gender: Both

Race/Ethnicity: Black, Asian/Pacific Islander, Hispanic, White, Other

Geography: Suburban, Urban

Setting (Delivery): Inpatient/Outpatient, Other Community Setting

Program Type: Cognitive Behavioral Treatment, Individual Therapy

Current Program Status: Active

Listed by Other Directories: Model Programs Guide

Program Director:
Daniel Cheron
Director of Training and Chief Psychologist
Judge Baker Children’s Center
53 Parker Hill Avenue
Boston MA 02120-3225
Phone: 617.278.4265
Website
Email

Training and TA Provider:
Teri Bourdeau
Director of Training
PracticeWise, LLC
340 Lee Avenue
Melbourne FL 32935
Phone: 321.426.4109
Website
Email

Training and TA Provider:
Sarah Tannenbaum
Associate Director of the Summer Enrichment Institute and Staff Psychologist at the Center for Effective Child Therapy
Judge Baker Children’s Center
53 Parker Hill Avenue
Boston MA 02120-3225
Phone: 617.232.8390
Website
Email