A Core-Competency Perspective on Family-Based Intervention for Child and Adolescent Mental Health

Abstract

Many fields of education have undergone a shift away from training models focused on traditional learning and assessment practices towards models that are competency based. In the field of clinical psychology, the competency-based movement has become particularly influential and has emphasized the need to support practitioners and trainees by identifying, teaching and assessing the competencies needed to effectively implement evidence-based practice in the treatment of mental health problems across the lifespan. Competence has been defined as ‘the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in the daily practice for the benefit of the individual and community served’ and depends on ‘habits of mind, including attentiveness, critical curiosity, self-awareness, and presence’ [1, p. 227]. Competencies encompass specific skills, behaviours, attitudes, knowledge and personal factors that influence a professional’s ability to execute evidence-based practice effectively in a range of areas, including assessment, case formulation and intervention [2, 3]. Competency-based education, training and assessment programmes have gained popularity in recent years because of the recognition that poor implementation of evidence-based practice (EBP) may be at least partly due to ineffective training approaches [4]. Evidence-based practice is defined as ‘the integration of the best available research with clinical expertise, in the context of patient characteristics, culture, and preferences’ [5, p. 1]. In recent decades, major advances have been made in the development and evaluation of evidence-based treatments for a wide range of mental health problems in children and adolescents, including depression [7] (see also Chapter 8), anxiety [6] (see also Chapter 9), conduct problems [8] (see also Chapter 10), attention deficit hyperactivity disorder (ADHD [9]; see also Chapter 11), autism spectrum disorder [11] (see also Chapter 13), eating disorders [10] (see also Chapter 14) and sleep problems (e.g., see Chapter 15). Importantly, the most effective treatments for child and adolescent psychopathology are often family based, in that they emphasize the active involvement of family members beyond the referred individual. In this chapter, we use the term family-based intervention to refer to any treatment that involves two or more family members, with at least one parent considered an ‘essential participant’ [12, 13]. Family-based interventions feature heavily in guidelines regarding empirically supported treatments (ESTs) that have been published by professional bodies (e.g., Division 12 of the American Psychological Association, American Psychiatric Association), multidisciplinary research networks (e.g., Cochrane Collaboration), and government organizations (e.g., the UK National Institute for Health and Care Excellence [NICE]) in recent years. Empirically supported treatments are typically classified as such after being shown to be effective in treating particular disorders in randomized, controlled trials (RCTs) comparing a manualized treatment protocol to either an active or wait-list control condition [14, 15]. However, despite the growing number of ESTs that now exist, only a small proportion of children and adolescents in the general population receive these treatments, and this is understood to be due in large part to a lack of appropriately trained therapists [16].