Alignment Between Clinician Treatment Choices and Client Data as a Predictor of Youth Clinical Outcomes.

Abstract

OBJECTIVE Experts have called for tools to enhance the effectiveness and acceptability of youth psychotherapy, such as methods designed to increase clinician-client alignment. Transdiagnostic youth psychotherapies, such as Modular Approach to Therapy for Children (MATCH), may be particularly strong candidates for these methods, as they involve complex decision-making processes that influence treatment plans and outcomes. In this study, we explored clinician-client alignment in the selection of an initial MATCH treatment protocol (anxiety, depression, trauma, or conduct problems). METHOD We used data from 196 youths (7-15 years old; 54% male; 32.5% White, 28% Black, 24% Latinx/Hispanic, 1% Asian, 13.5% multi-racial) receiving MATCH. We tested whether alignment - i.e. the extent to which the clinician-selected protocol aligned with the "best-fit" protocol for a given youth, based on youth and caregiver pre-treatment data - might predict trajectories of change in youth- and caregiver-reported severity of youth symptoms (Brief Problem Monitor) and idiographic top problems (Top Problems Assessment) across treatment. RESULTS Overall, outcomes tended to improve more when the clinician-selected protocol aligned with the best-fit protocol of at least one of the clients (i.e. caregiver client and/or youth client) than when the clinician-selected protocol did not align with the best-fit protocol of either client. CONCLUSIONS To our knowledge, this is the first study to demonstrate that clinician-client alignment may be associated with improved outcomes in youth psychotherapy. These findings highlight the potential clinical value of using pre-treatment client data to inform the clinician's critical decision of which treatment focus to pursue.