Op 26 november 2020 organiseerde ZonMw, samen met de 7 onderzoeksconsortia, een internationaal congres over de geleerde lessen van onderzoek naar kernelementen van jeugdinterventies.
In de consortia Effectiviteit psychosociale interventies Jeugd sloegen onderzoekers en jeugdhulpinstellingen nieuwe wegen van effectonderzoek in op 7 grotere inhoudelijke thema’s rond opgroeien en opvoeden. Het onderzoek levert kennis op over welke (delen van) interventies wanneer, bij wie en door wie het beste ingezet kunnen worden. Vertrekpunt daarbij zijn de kernelementen van bewezen effectieve interventies. De consortia geven met vernieuwend effectonderzoek antwoord op vragen als: Wat maakt eigenlijk dat een interventie werkt? Zijn er werkende factoren die in alle interventies zitten? Hoe kan de hulpverlener invloed uitoefenen op het effect? En: welke interventies of onderdelen daarvan zijn kosteneffectief? Het onderzoek in de consortia richt zich op de volgende thema's:
- Angst en depressie
- ADHD en druk gedrag
- Sociale vaardigheden en weerbaarheid
- Externaliserend probleemgedrag
- Multiprobleemgezinnen
- Lichte opvoedondersteuning
- Vroege preventie en interventies tegen kindermishandeling
Hieronder vindt u samenvattingen van de sessies en de presentaties van de consortia. Gezien het internationale karakter van de bijeenkomst zijn alle presentaties in het Engels.
Opening - Can we identify best bets for the active ingredients of interventions (by Prof M Wolpert)
Miranda showed us different active ingredients of interventions, including and what we know about them. But, just like our meals, we like them made of different ingredients and different amounts of ingredients. What works when for who in an intervention is also depending on the individual, time and place.
Subsessions
Subsession 1 - Microtrials: the way forward for research into the effectiveness of treatment components?
Over the past four years, six large scale randomized controlled microtrials investigated effective treatment components for several common childhood psychiatric problems (i.e., social skills deficit, anxiety, depression, externalizing behavior problems, and ADHD). Although all the studies were defined as microtrials, they varied greatly concerning design and outcome measures used to compare component effectiveness. This session provided a brief overview of the studies before discussing their main results and implications. Next, a discussion examined whether microtrials are the way forward for research into the effectiveness of treatment components. Possibilities for the future use of microtrial designs were also discussed.
Subsession 2 - How mixed-method studies can help to gain a better understandig of effective elements of interventions
In this workshop we addressed and showed in which way qualitative data, in combination with quantitative data, can help to better understand why and how elements of interventions lead to positive change within children/parents/families. Harrie Jonkman presented results of his research among professionals and experts in the field of family interventions. Loraine Visscher presented how interviews with children and parents on helpful and unhelpful elements of interventions were designed and conducted. An overview of the results of this study was also presented. The discussion was be about the added value of using mixed-methods within research on effective elements of interventions.
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Subsession 3 - Various applications of a treatment taxonomy; It’s more than just coding
There are so many treatments for youth that’s it’s difficult to say to which degree they are similar and to which degree they differ. This is important to gain insight into the effective core elements of these treatments. In this context, the research consortia have developed a generic taxonomy to differentiate between the different elements of treatments. With this generic taxonomy, one can code various treatment manuals in order to map the presence of content specific components, contextual factors (e.g., target group, goal) and structural factors (e.g. group/individual, number of sessions). In this workshop the development of a generic taxonomy is presented, together with some specific applications namely:
- the use of the taxonomy in meta-analyses and the development of CBT modules,
- the use of the taxonomy to develop a treatment decision aid,
- the use of the taxonomy to design a registration system
Subsession 4 - Using meta-analytic data in search for effective treatment components: current findings and innovations with network meta analyses
Treatments for children, young people, parents and teachers mostly consist of multiple components and take place in multiple contexts. One approach to identify treatment components that contribute most to effectiveness of these treatment packages, is to integrate the results from trials: a meta analytic approach. Several consortia have conducted meta-analyses in search for effective treatment components in their field, using various methodologies. First, five meta-analyses were briefly presented by members of different consortia.
Network meta analyses have some benefits over conventional meta analyses. Pim Cuijpers presented the backgrounds and an example of network meta analyses, and discuss the potential and pitfalls of network meta analyses in the context of treatment components.
We concluded with an interactive Q&A session for further clarification and for discussing the potential of using meta analytic data to identify effective treatment components.
Subsession 5 - Using clinical data to identify critical intervention elements
Clinicians, teachers, and other professionals working with children and youth are highly motivated to attain the best possible effects with their clients and pupils. They are also frequently involved in systematic data collection, for example for student monitoring systems, routine outcome monitoring, or goal attainment scaling. Yet surprisingly, in our experience, working effectively and collecting data appear to be separate activities in many professionals’ lives.
In this symposium, we aimed to demonstrate how clinically obtained data can directly contribute to better identification and improvement of core elements in (preventive) intervention for youth.
To this end, 3 examples were presented of ways to do so in different contexts:
- In a preventive school context, the intervention approach Toppertraining (Kanjertraining) can be delivered in different modalities, such as to a whole classroom or to individual students; and by the teacher or by a trained psychologist. De Mooij et al. examined which modality is most effective for whom, by analyzing routinely collected longitudinal student and teacher data on children’s well-being and social functioning.
- In a family intervention context, effective intervention for perpetrators and victims of child abuse seems to depend on core elements that fit the risks and needs of client systems. To identify these, Bijlsma et al. conducted secondary data analyses on multiple client databases of perpetrators (de Waag) and victims of child abuse (de Viersprong MST-CAN). Using network analyses, she identified feedback loops between maintaining factors to be addressed in tailored intervention.
- In secure residential youth care (JZ+) institutions, the problems of juvenile clients and their parents are often intertwined. To reach treatment outcomes that last post treatment, it seems important to work family centred. Blankestein and Broekhoven et al. examined the effects of family-centeredness in seven secure residential youth care institutions in the Netherlands in relation to treatment outcomes of 409 juvenile clients from pre-test to 6 months after treatment.
Unfortunately, there is no video of the session available.
Subsession 6 - Insight into effective elements of interventions through observational studies
In this workshop, Hein Raat and Loraine Visscher presented two observational studies on effective elements of interventions. Within the ZOP&GMCP consortium a quasi-experimental study was conducted to gain insight into effective elements of interventions for families with severe parenting problems or multiple problems. Within the CIKEO consortium, a prospective cohort study was conducted to investigate the exposure of parents/caregivers to (preventive) parenting support elements and strategies in daily practice of Dutch preventive youth health care and the effects of this exposure on parenting, family functioning and child development in a naturalistic effect evaluation. They discussed study designs, results and the value of observational studies in identifying elements that are associated with positive outcomes in parents/families.
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Subsession 7 - Individual participant data meta-analysis (IPDMA) – advantages and challenges
In ‘Individual participant data’ (IPD) meta-analyses the primary data of randomized trials are collected and integrated into one big dataset. IPD meta-analyses have several advantages over conventional meta-analyses. However, there are also several challenges. In the first presentation of this session Pim Cuijpers discussed some of the advantages and challenges of IPD studies. This was followed by presentations on three IPD studies that have been performed in the Netherlands as part of the Consortia studies. Maud Hensums presented an IPD study of anti-bullying interventions. Matthijs Oud presented results from an IPD study on the effects of CBT for youths with depression. Finally, Annabeth Groenman presented the IPD study on effects of behavioral therapy for ADHD-youths. Presenters discussed both the challenges and advantages that they encountered during their IPD-studies and some of the major finding that resulted from these studies.
Unfortunately, there is no video or presentation of the session available.
Subsession 8 - Single-case experimental designs: strategies and lessons learned
In this sub-session, the results of three different studies using the single-case experimental design (SCED) were presented and discussed. The first study was aimed at examining the added value of targeting specific risk factors for child maltreatment within an evidence-base home visitation program. The second study was aimed at examining antecedent and consequent techniques of a parent training for parents of children with ADHD. The third study was aimed at examining the effectiveness of an intensive exposure treatment program for anxious youth.
In this session, we payed particular attention to the methodology and statistical techniques used and the practical and methodological problems that arose. What lessons can be learned from the experiences of the researchers of the different consortia?
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Subsession 9 - Core elements: from knowledge transfer to implementation and impact
The uptake of evidence-based interventions and elements is often low and slow. In this session they discussed methods that are used to translate knowledge into practice. Loraine Visscher discussed how they used dialogue-sessions to interact with professionals and families about their findings and to create useable products. Bram Orobio presented how they developed and piloted a decision-tree that supports professionals in tailoring interventions to the needs of youth with severe behavioural problems. Clemens Hosman then discussed how to have an impact and reach parents with interventions such as preventive parenting interventions and its core elements. The IM-PACT Management model was developed describing strategies to improve this impact of interventions.
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Closing - Do we know how psychological interventions work (by Prof P Cuijper)
Understanding how interventions work may help in improving outcomes of these interventions and making them more accessible. To examine whether interventions are effective can be done through randomized trials. How to examine the working mechanisms of interventions is, however, much more complicated and not straightforward. This is a dilemma for researchers and policy makers. In this lecture he focussed on the methods how to examine effective mechanisms and how future research can help in a better understanding of effective mechanisms.