From the laboratory to the office: Implementation and sequencing of evidence-based treatment components for newly diagnosed childhood psychiatric disorders in a large health system.

Despite increasingly behaviorally based efficacious treatments for youth diagnosed with a range of psychiatric disorders, most receive no care or suboptimal care. Little is known about the content and sequencing of mental health interventions delivered in nonresearch clinical settings, which limits efforts to disseminate and implement effective treatments. We abstracted the health records of 694 children aged 7–17 (M = 11.97, SD = 3.4) newly diagnosed with a psychiatric disorder in 2013 within a large health system. The sample was 52.6% female and 81.4% White; just over half of youth completed at least one treatment session in the year after their diagnosis. Cognitive components were the most frequently used component overall (49.2%), followed by medication (38.1%) and behavioral (28.9%) components. The sequencing of treatment components suggests that medication alone was most common in the first two appointments (38.5%), followed by cognitive and then behavioral strategies. Patterns of treatment were also examined across provider type and diagnosis and are discussed. Findings suggest that the study of clinical methods should be emphasized and increased access to evidence-based care is needed, particularly for behavioral treatments early in treatment.