title: 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.
abstract: 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', Māori-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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry ACTRN12614000297628 .
authors.affiliation: Department of Health and Social Care, The Open University, Walton Hall, Milton Keynes, MK7 6AA, UK. mathijs.lucassen@open.ac.uk.|Department of Psychological Medicine, School of Medicine, Level 12 Auckland City Hospital Support Building, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand. mathijs.lucassen@open.ac.uk.
authors.forename: Mathijs F G
authors.initials: MF
authors.lastname: Lucassen
authors.affiliation: Department of Psychological Medicine, School of Medicine, Level 12 Auckland City Hospital Support Building, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand. k.stasiak@auckland.ac.nz.
authors.forename: Karolina
authors.initials: K
authors.lastname: Stasiak
authors.affiliation: Invercargill Medical Centre, 160 Don Street, Invercargill, New Zealand. screnglemahi@actrix.co.nz.
authors.forename: Sue
authors.initials: S
authors.lastname: Crengle
authors.affiliation: Department of Psychology, Harvard University, 1030 William James Hall, 33 Kirkland Street, Cambridge, MA, 02138, USA. John_Weisz@harvard.edu.
authors.forename: John R
authors.initials: JR
authors.lastname: Weisz
authors.affiliation: Department of Psychological Medicine, University of Otago (Christchurch), 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand. chris.frampton@otago.ac.nz.
authors.forename: Christopher M A
authors.initials: CM
authors.lastname: Frampton
authors.affiliation: Department of Educational Psychology, The University of Texas at Austin, 1912 Speedway, Stop D5800, Austin, TX, 78712-1289, USA. skbearman@austin.utexas.edu.
authors.forename: Sarah Kate
authors.initials: SK
authors.lastname: Bearman
authors.affiliation: Private clinical psychologist, Houston, USA. ana.ugueto@gmail.com.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Ugueto
authors.affiliation: Department of Psychiatry and Human Behavior, Brown University, Box G-BH, Providence, RI, 02912, USA. jennifer_herren@brown.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Herren
authors.affiliation: Whirinaki, Counties Manukau District Health Board, PO Box 217198, Botany Junction, Auckland, 2164, New Zealand. Ainsleigh.Cribb@middlemore.co.nz.
authors.forename: Ainsleigh
authors.initials: A
authors.lastname: Cribb-Su'a
authors.affiliation: Le Va, PO Box 76536, Manukau City, Auckland, 2241, New Zealand. monique.faleafa@leva.co.nz.
authors.forename: Monique
authors.initials: M
authors.lastname: Faleafa
authors.affiliation: Le Va, PO Box 76536, Manukau City, Auckland, 2241, New Zealand. denise.kingi-uluave@leva.co.nz.
authors.forename: Denise
authors.initials: D
authors.lastname: Kingi-'Ulu'ave
authors.affiliation: Infant, Child, and Adolescent Mental Health Services, Waikato District Health Board, Pembroke Street, Private Bag 3200, Hamilton, 3240, New Zealand. Jik.Loy@waikatodhb.health.nz.
authors.forename: Jik
authors.initials: J
authors.lastname: Loy
authors.affiliation: Department of Psychological Medicine, School of Medicine, Level 12 Auckland City Hospital Support Building, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand. becca.scott@waitematadhb.govt.nz.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Scott
authors.affiliation: Department of Psychological Medicine, School of Medicine, Level 12 Auckland City Hospital Support Building, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand. m.hartdegen@auckland.ac.nz.
authors.forename: Morgyn
authors.initials: M
authors.lastname: Hartdegen
authors.affiliation: Department of Psychological Medicine, School of Medicine, Level 12 Auckland City Hospital Support Building, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand. s.merry@auckland.ac.nz.
authors.forename: Sally N
authors.initials: SN
authors.lastname: Merry
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D016497:Adolescent Health Services; D000367:Age Factors; D000465:Algorithms; D000553:Ambulatory Care; D001007:Anxiety / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D002648:Child; D002652:Child Behavior; D002662:Child Health Services; D002985:Clinical Protocols; D019955:Conduct Disorder / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D003863:Depression / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008605:Mental Health Services; D009520:New Zealand / Q000453:epidemiology; D018579:Patient Selection; D011569:Psychiatric Status Rating Scales; D000067073:Psychological Trauma / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D011613:Psychotherapy / Q000379:methods*; D018401:Sample Size; D013997:Time Factors; D016896:Treatment Outcome