Modular Approach to Therapy for Anxiety, Depression, Trauma, or Conduct Problems in outpatient child and adolescent mental health services in New Zealand: study protocol for a randomized controlled trial.

BACKGROUND: Mental health disorders are common and disabling for young people because of the potential to disrupt key developmental tasks. Implementation of evidence-based psychosocial therapies in New Zealand is limited, owing to the inaccessibility, length, and cost of training in these therapies. Furthermore, most therapies address one problem area at a time, although comorbidity and changing clinical needs commonly occur in practice. A more flexible approach is needed. The Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH-ADTC) is designed to overcome these challenges; it provides a range of treatment modules addressing different problems, within a single training program. A clinical trial of MATCH-ADTC in the USA showed that MATCH-ADTC outperformed usual care and standard evidence-based treatment on several clinical measures. We aim to replicate these findings and evaluate the impact of providing training and supervision in MATCH-ADTC to: (1) improve clinical outcomes for youth attending mental health services; (2) increase the amount of evidence-based therapy content; (3) increase the efficiency of service delivery. METHODS: This is an assessor-blinded multi-site effectiveness randomized controlled trial. Randomization occurs at two levels: (1) clinicians (≥60) are randomized to intervention or usual care; (2) youth participants (7-14 years old) accepted for treatment in child and adolescent mental health services (with a primary disorder that includes anxiety, depression, trauma-related symptoms, or disruptive behavior) are randomly allocated to receive MATCH-ADTC or usual care. Youth participants are recruited from 'mainstream', Maori-specific, and Pacific-specific child and adolescent mental health services. We originally planned to recruit 400 youth participants, but this has been revised to 200 participants. Centralized computer randomization ensures allocation concealment. The primary outcome measures are: (i) the difference in trajectory of change of clinical severity between groups (using the parent-rated Brief Problem Monitor); (ii) clinicians' use of evidence-based treatment procedures during therapy sessions; (iii) total time spent by clinicians delivering therapy. DISCUSSION: If MATCH-ADTC demonstrates effectiveness it could offer a practical efficient method to increase access to evidence-based therapies, and improve outcomes for youth attending secondary care services. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12614000297628 .

Community rehabilitation outcomes across cultures following traumatic brain injury.

OBJECTIVE: This exploratory study investigates Traumatic Brain Injury (TBI) rehabilitation outcomes among culturally diverse outpatients in community-based rehabilitation who have sustained a Mild to Moderate TBI. The major aims of this study are twofold: firstly, to determine whether community-based rehabilitation outcomes following TBI differ across Maori, Pacific and Pakeha cultures; and secondly, to identify any service delivery needs Pacific people in TBI rehabilitation require that may be distinct from Pakeha. METHOD: A fixed comparative non-experimental design was utilised where participants were selected using direct control based on their self-identified ethnic group resulting in sub-samples of 11 Maori, 11 Pacific and 11 Pakeha (n=33). Each participant completed the Neurobehavioural Cognitive Status Examination (Cognistat) and the Brain Injury Community Rehabilitation Outcome Scales (BICRO-39 Scales). RESULTS: Results indicate that all participants were at a similar level of overall cognitive functioning but Pacific peoples scored significantly lower than both Maori and Pakeha on two Language subtests and significantly lower than Pakeha on the Memory subtest. Individual handicap increased following TBI and decreased following rehabilitation, with no significant difference across cultures and suggesting good efficacy of rehabilitation. CONCLUSION: There appears to be universalities in TBI experience and global rehabilitation outcomes that transcends individual cultures. However; there are micro-level cultural variations that have valuable implications when assessing and treating Pacific people in neuro-rehabilitation. Neuropsychologists need to take into account formal education levels and language abilities when working with Pacific people.