Adherence to Evidence-Based Approaches to Early Childhood Mental Health
Abstract
Introduction: Established treatment algorithms for very young children recommend psychotherapy as the first-line treatment for most clinical conditions (Gleason et al., 2007), with medication acting as a supplemental treatment if psychotherapy alone is insufficient. However, past research shows that many young children receive treatment plans that do not align with established guidelines, suggesting that there are factors affecting clinical decisions. Therefore, this project aimed to examine the treatment plans recommended to young patients at CHKD and their adherence to published treatment guidelines based on diagnosis and level of impairment. Also of interest was if any moderators appeared to influence adherence based on demographic or clinical factors.
Methods: Retrospective chart reviews were conducted of 233 patients under the age of 6 who were seen for a Brief Clinical Needs Assessment (BCNA; their initial triage appointment) between July 2023 and June 2024. Data extracted included demographic information (sex, race, primary language, insurance status), diagnosis/symptom category, past history of treatment, current medications, impairment level, and treatment recommendations. These treatment plans were then compared to published guidelines to assess for adherence.
Results: Recommended treatment plans aligned with established treatment guidelines in 67.0% (n=155) of cases. However, there is room for improvement: 27.5% (n=64) of plans only partially aligned and 5.6% (n=13) of plans did not align at all. Of the 64 plans that only partially aligned, most included a psychiatry referral being indicated but not done (55%; n=35) or inappropriate psychological testing (60%; n=38). Patient age, race, sex, and insurance status did not appear to influence adherence. However, clinicians still in training were less likely to recommend treatment plans that were fully adherent (56.8%; n=63) compared to their licensed supervisors (85.6; n=30%).
Conclusion: Overall, most plans of care aligned with published recommendations. Importantly, adherence to guidelines was not associated with demographic factors usually associated with disparities. Additionally, even with real time supervision, unlicensed assessors had lower rates of adherence than independently practicing licensed clinicians. Attention to training and the supervision process will promote adherence to published guidelines and ensure that services are being referred to appropriately.