Common Elements Approach Research Articles

Developing a definition of body neutrality and strategies for an intervention

The aim of this study was to provide a definition for body neutrality and understand the key strategies recommended to improve body neutrality for testing in future interventions. There is minimal academic literature on body neutrality and thus this study focused on examining websites where the concept has been discussed for some time. This was achieved using a realist synthesis of websites and a common elements approach to extract the key definition elements of body neutrality, strategies to improve body neutrality, in addition to the common critiques of both the body positivity and body neutrality movements. The initial search found 175 websites, of which 107 were included in the final synthesis, and common elements analysis followed after removal of duplicates and ineligible websites. Three elements, with several sub-elements, best operationalised the definition of body neutrality. Six strategies were found for development of a body neutrality intervention. This innovative study paves the way for rigorous evaluation of body neutrality. Recommendations for future work are provided, including the use of current measures, creating a new measure, and evaluating prevention and intervention programs including Single Session Interventions (SSIs).

Practitioner Review: Common elements in treatments for youth suicide attempts and self-harm - a practitioner review based on review of treatment elements associated with intervention benefits.

Adopting a common elements approach, this practitioner review aims to highlight specific treatment elements that are common to interventions with demonstrated benefits in randomized controlled trials (RCTs) for reducing suicide attempts and self-harm in youth. Identification of common treatment elements among effective interventions offers a key strategy for clarifying the most robust features of effective interventions and improving our ability to implement effective treatment and decrease the lag between scientific advances and clinical care. A systematic search of RCTs evaluating interventions targeting suicide/self-harm in youth (ages 12-18) yielded a total of 18 RCTs assessing 16 different manualized interventions. An open coding process was used to identify common elements present within each intervention trial. Twenty-seven common elements were identified and classified into format, process, and content categories. All trials were coded for the inclusion of these common elements by two independent raters. RCTs were also classified into those where trial results supported improvements in suicide/self-harm behavior (n=11 supported trials) and those without supported evidence (n=7 unsupported trials). Compared with unsupported trials, the 11 supported trials shared the following elements: (a) inclusion of therapy for both the youth and family/caregivers; (b) an emphasis on relationship-building and the therapeutic alliance; (c) utilization of an individualized case conceptualization to guide treatment; (d) provided skills training (e.g. emotion regulation skills) to both youth and their parents/caregivers; and (e) lethal means restriction counseling as part of self-harm monitoring and safety planning. This review highlights key treatment elements associated with efficacy that community practitioners can incorporate in their treatments for youth presenting with suicide/self-harm behaviors.

A systematic review of common elements of practice that support reunification

A proliferation of programs and interventions aim to promote permanency for children and young people in contact with the child welfare system. Many are manualized and evaluated at the program-level rather than at practice-level. Interest is growing in the common elements approach, to determine which individual program components are most useful for informing practice. This paper draws from the findings of a systematic review that assessed current research on permanency programs and utilized a common elements approach to identify practices that support permanency via reunification, guardianship or adoption. The focus of this paper is on practice elements that are common for supporting parents towards reunification. Twelve publications met inclusion criteria: seven experimental (randomized controlled trial) studies, two quasi-experimental studies, and three pretest–posttest studies. From these, 10 programs were identified that aim to build the capacity of parents undertaking reunification efforts to promote their children’s safety, stability, and security. Using content analysis, a total of eight distinct practices in reunification programs were identified; these practices applied a structured and individualized approach to improve parent–child interactions and build parent skills to recognize and respond to child behavioral issues. The common elements approach reveals the components of evidence-based interventions to support reunification and can be useful for tailoring interventions, developing frameworks, upskilling workforce and identifying effective practices within existing interventions.

A common elements approach to the development of a modular cognitive behavioral theory for chronic loneliness.

Loneliness is a transdiagnostic clinical phenomenon that can significantly impact mental health and well-being across the lifespan. The aim was to combine existing theory and evidence-based treatment approaches to propose a comprehensive transdiagnostic cognitive-behavioral analysis of the maintenance of chronic loneliness relevant across disorders, age groups, and populations. A distillation and matching model-framework approach was taken to identify interventions designed to reduce loneliness. Eligible studies were coded for the presence of practice elements. The findings were combined with an analysis of the broader literature on loneliness and psychopathology to derive a comprehensive cognitive-behavioral analysis of the maintenance of loneliness over time across populations. The search yielded 11 studies containing 14 practice elements with relative frequencies ranging from 7% to 64%. The identified practice elements target putative mechanisms such as negative interpersonal appraisals, anxiety, and social skills deficits. Counterproductive behavior and cognitive processes such as self-focused attention were identified as maintenance factors based on the broader literature. A modular transdiagnostic model with multiple pathways is proposed to be consistent with the existing theoretical and treatment literature. Combining the distillation and matching model framework with existing theory from the literature is a novel approach for developing a model of factors that maintain loneliness over time. The model has varying treatment implications for different populations including children with autism spectrum disorders and bereaved older adults. Targeting transdiagnostic processes has the potential to transform interventions for loneliness across a range of formats and settings. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Development of the WHO Caregiver Skills Training Program for Developmental Disorders or Delays.

Globally, 52.9 million children under the age of 5 experience a developmental disability, such as sensory impairment, intellectual disability, and autism spectrum disorders. Of these 95% live in low-and-middle-income countries. Most of these children lack access to care. In light of the growing evidence that caregivers can learn skills to support their children’s social communication and adaptive behavior and to reduce their challenging behavior, the World Health Organization developed a novel Caregiver Skills Training Program (CST) for families of children with developmental disorders or delay to address such treatment gap. This report outlines the development process, content, and global field-testing strategy of the WHO CST program. The CST program is designed to be feasible, scalable, and adaptable and appropriate for implementation in low-resource settings by nonspecialists. The program was informed by an evidence review utilizing a common elements approach and was developed through extensive stakeholder consultation and an iterative revision process. The program is intended for a global audience and was designed to be adapted to the cultural, socioeconomic, geographic, and resource context in which it is used to ensure that it is comprehensible, acceptable, feasible, and relevant to target users. It is currently undergoing field-testing in more than 30 countries across all world regions.

A Cluster Randomized-Controlled Trial of the MindOut Social and Emotional Learning Program for Disadvantaged Post-Primary School Students.

School-based social and emotional learning programs aim to provide students with the skills they need to deal with life challenges, thereby enhancing their social and emotional wellbeing, academic outcomes, and reducing their risk of mental health difficulties. While there is a robust evidence base on the effectiveness of these programs originating from the US, there is a relative paucity of research on how these programs impact young people in other county contexts, especially for older adolescents and those at higher risk. This study sets out to address this research gap by evaluating the effectiveness of a social emotional learning program designed for older adolescents in Ireland, the MindOut program. MindOut is a universal school-based social and emotional learning program designed for older adolescents in Ireland which was developed based on a common elements approach underpinned by CASEL's framework. Employing a cluster randomized-controlled trial, data on social and emotional skills, academic performance and mental health outcomes were collected from students (n = 497; 51.1% female) ages 15-18 years in 32 disadvantaged schools. There were significant improvements in intervention students' social and emotional skills including, reduced suppression of emotions (p = 0.035), use of more positive coping strategies [reduced avoidance coping p = < 0.001) and increased social support coping p = 0.044)]. Improvements in mental health and wellbeing were also found with significantly reduced levels of stress (p = 0.017) and depressive symptoms (p = 0.030) as well as reduced anxiety scores for females students (p = 0.044). These short-term evaluation findings support the positive impact of school-based social and emotional learning programs, such as MindOut, when designed to be both age and culturally appropriate and delivered to older adolescents in disadvantaged schools.

Factors Associated with Community-Partnered School Behavioral Health Clinicians' Adoption and Implementation of Evidence-Based Practices.

Community-partnered school behavioral health (CP-SBH) is a model whereby schools partner with local community agencies to deliver services. This mixed-methods study examined 80 CP-SBH clinicians' adoption and implementation of evidence-based practice (EBP) approaches following mandated training. Forty-four clinicians were randomly assigned to one of two training conditions for a modular common elements approach to EBPs; 36 clinicians were preselected for training in a non-modular EBP. EBP knowledge improved for all training conditions at 8-month follow-up and practice element familiarity improved for modular approach training conditions, but the modular condition including ongoing consultation did not yield better results. Qualitative interviews (N = 17) highlighted multi-level influences of the CP-SBH service systemand individual cliniciancharacteristics on adoption and implementation.

An evaluation of a common elements treatment approach for youth in Somali refugee camps.

This paper reports on: (1) an evaluation of a common elements treatment approach (CETA) developed for comorbid presentations of depression, anxiety, traumatic stress, and/or externalizing symptoms among children in three Somali refugee camps on the Ethiopian/Somali border, and (2) an evaluation of implementation factors from the perspective of staff, lay providers, and families who engaged in the intervention. This project was conducted in three refugee camps and utilized locally validated mental health instruments for internalizing, externalizing, and posttraumatic stress (PTS) symptoms. Participants were recruited from either a validity study or from referrals from social workers within International Rescue Committee Programs. Lay providers delivered CETA to youth (CETA-Youth) and families, and symptoms were re-assessed post-treatment. Providers and families responded to a semi-structured interview to assess implementation factors. Children who participated in the CETA-Youth open trial reported significant decreases in symptoms of internalizing (d=1.37), externalizing (d=0.85), and posttraumatic stress (d=1.71), and improvements in well-being (d=0.75). Caregivers also reported significant decreases in child symptoms. Qualitative results were positive toward the acceptability and appropriateness of treatment, and its feasibility. This project is the first to examine a common elements approach (CETA: defined as flexible delivery of elements, order, and dosing) with children and caregivers in a low-resource setting with delivery by lay providers. CETA-Youth may offer an effective treatment that is easier to implement and scale-up versus multiple focal interventions. A fullscale randomized clinical trial is warranted.

Promoting social and emotional well-being in schools

PurposeThe purpose of this paper is to provide a critical perspective on the international evidence on promoting young people’s social and emotional well-being in schools. The challenges of integrating evidence-based interventions within schools are discussed and the need for innovative approaches to research and practice are considered in order to support more sustainable approaches that can be embedded into the everyday practice of school systems.Design/methodology/approachA common elements approach to intervention development and implementation is explored. A case study is presented on piloting this approach with post-primary students, based on consultations with students and teachers concerning their needs in supporting youth social and emotional well-being.FindingsThe integration and sustainability of evidence-based social and emotional skills programmes within the context of whole school systems is far from clearly established. Research on the use of a common elements approach to evidence-based treatment and youth prevention programmes is presented and the application of this method to the development and implementation of social and emotional learning interventions is considered. Preliminary case study findings are presented exploring this approach in school-based intervention development for post-primary school students.Research limitations/implicationsThe potential of adopting a common elements approach is considered; however, more rigorous research is needed to identify the most potent strategies for social and emotional skills development.Originality/valueIdentifying a common set of evidence-based strategies for enhancing adolescents’ social and emotional skills could lead to innovative approaches to intervention delivery that would extend the impact and reach of evidence-based practice across diverse educational systems and school settings.

From Top-Down to Bottom-Up Climate Policy: New Challenges in Carbon Market Design

The climate policy debate underwent a profound shift between 2009-2016. Prior to that point, efforts at the domestic and international levels focused on broad, top-down strategies to reduce greenhouse gas (GHG) emissions, with market-based mechanisms expected to play a key role. The simultaneous breakdown of the congressional climate policy debate and the failure of the United Nations Framework Convention on Climate Change (UNFCCC) to produce a new international agreement at the meeting in Copenhagen raised serious questions about the political viability of carbon markets, as well as the prospects for implementing meaningful near-term emission abatement strategies. A number of bottom-up strategies have since emerged, including subnational experimentation with carbon market design, emissions trading options under the U.S. Environmental Protection Agency’s Clean Power Plan, and the UNFCCC’s focus on individual emission reduction commitments by member nations. These incremental steps represent important progress, but are incapable of stabilizing or reducing atmospheric GHG concentrations on their own. The ultimate success of the decentralized mitigation approaches currently underway, therefore, depends upon their ability to foster broader action. This Article explores the shift from top-down to bottom-up approaches to carbon market design, focusing on three strategies that have emerged since 2009: the California Cap-and-Trade Program, the Clean Power Plan, and the UNFCCC process. The Article then examines the prospects for broad multilateral markets to emerge under a bottom-up approach and identifies three pathways to streamline market design choices: a coordinated approach; a dominant actor approach; and a common elements approach.

Pathways Forward for Embracing Evidence-Based Practice in Group Care Settings

Evidence-based practices are often discussed but less easily implemented. Almost all the existing manualized, diagnostic-specific evidence-based practices were neither designed for nor tested in residential programs. However, a recent survey of group care providers found great interest and some success in infusing evidence-based programs and practices in serving youth. This article described four possible pathways for group care programs to pursue to advance the use of evidence-based practices and programs. These examples include using the common elements approach, building a home-grown program and its evidence, adapting an existing manualized practice for a group care setting, and adapting a residential program to incorporate an evidence-based practice. An extended case study is provided to illustrate the process and potential challenges of creating an intervention and testing it in a group care setting.

Testing the effectiveness of a transdiagnostic treatment approach in reducing violence and alcohol abuse among families in Zambia: study protocol of the Violence and Alcohol Treatment (VATU) trial

Violence against women and girls (VAWG) is an urgent global health problem. Root causes for VAWG include the individual- and family-level factors of alcohol abuse, mental health problems, violence exposure, and related adverse experiences. Few studies in low- and middle-income countries (LMIC) have assessed the effectiveness of psychological interventions for reducing VAWG. This randomized controlled trial, part of the What Works to Prevent Violence Against Women and Girls consortium, examines the effectiveness of a common elements treatment approach (CETA) for reducing VAWG and comorbid alcohol abuse among families in Zambia. Study participants are families consisting of three persons: an adult woman, her male husband or partner, and one of her children aged 8-17 (if available). Eligibility criteria include experience of moderate-to-severe intimate partner violence by the woman and hazardous alcohol use by her male partner. Family units are randomized to receive CETA or treatment as usual. The primary outcome is VAWG as measured by the Severity of Violence Against Women Scale, assessed along with secondary outcomes at 24 months post-baseline. Interim assessments are also conducted at 4-5 months (following CETA completion) and 12 months post-baseline. This ongoing trial is one of the first in sub-Saharan Africa to evaluate the use of an evidence-based common elements approach for reducing VAWG by targeting a range of individual- and family-level factors, including alcohol abuse. Results of this trial will inform policy on what interventions work to prevent VAWG in LMIC with local perspectives on scale up and wider implementation.

Rethinking the service delivery system of psychological interventions in low and middle income countries.

BackgroundGlobal mental health is a growing field intricately connected to broader health, violence and economic issues. Despite the high prevalence and cost of mental health disorders, an estimated 75 % of those with need in lower resource settings do not receive intervention. Most studies to date have examined the effectiveness of single-disorder mental health treatments – an approach that may be a significant challenge to scale-up and sustainability in lower resource settings.Main bodyThis paper presents a brief overview of the scientific progress in global mental health, and suggests consideration of an internal stepped care delivery approach. An internal stepped care model is one idea of a delivery system, utilizing a common elements approach, where the same provider could navigate between different elements based on severity and type of problems of the client. It is distinct from traditional stepped care models in that clients remain with the same provider, rather than relying on referral systems.ConclusionAn internal stepped care delivery system based on a simplified common elements approach could be more efficient, scalable, sustainable, and reduce the loss of clients to referrals in lower resource settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0938-y) contains supplementary material, which is available to authorized users.

Practising for Social Work Practice: Integrating Knowledge and Skills for Social Work with Children and Families

The UK Government has categorically stated in its Knowledge and Skills Statement for Children and Family Social Work what social workers need to know and be able to do when responding to concerns about children. The Hope for Children and Families modular systemic interventions programme provides evidence informed responses for targeting harmful parenting and the associated impairment of children. The training resources, developed by Bentovim et al., apply the ‘common elements approach’ and are aimed at qualified practitioners. However, there also appears to be scope for their use in social work qualifying programmes. This paper will review the development of an undergraduate children and families module using the materials. It discusses how these resources were incorporated into a learning, teaching and assessment strategy which aims to develop and test the interpersonal components of knowledge and skills alongside technical/procedural knowledge. The outcomes indicate that these resources have contributed significantly in closing the gap between study and practice by providing an applied starting point from which learners can critically engage in the complexities of what they need to know and be able to do to be effective practitioners. Further use of these resources across programmes is recommended.

Client Report of Delivery of Common Elements in Usual Care and the Association to Satisfaction

Recently, scholars have advocated for the use of a new flexible approach to evidence-based practice through the use of “common elements”, which are treatment procedures that are utilized in a variety of evidence-based mental health interventions. The objective of this study was to describe the extent to which clinicians are using common elements of evidence-based treatment (EBT) in routine mental health care for children and if they are utilizing more of the elements associated with their client’s diagnosis. A second objective was to determine whether use of these elements was associated with client satisfaction. The Youth Services Survey was administered to a diverse sample of youth and their caregivers (total sample = 1075) to measure satisfaction with services and use of both talk-based and skill-based common elements. More than 74 % of caregivers indicated that their child’s clinician utilized the talk-based common elements frequently or almost always. Additionally, at least 69 % of youth agreed with this finding. Youth and caregivers reported that the common elements related to skill building were utilized less frequently. A Generalized Estimating Equation approach was used to examine the relationship between use of common elements and client diagnosis and satisfaction. The results for diagnosis were mixed and varied by parent and youth report. Finally, the more clinicians discussed and practiced common elements of EBT with their clients, both youth and caregivers were more likely to be satisfied. Due to clients’ reporting that on average clinicians utilized skill building common elements less often, targeted clinician training may be important, since practicing skill-building therapeutic elements is key to adopting new methods of managing behavior and emotions. Further, if families are more satisfied with a common elements approach, then clinicians may be more likely to utilize it.

Adopting a Resilience Practice Framework: a case study in what to select and how to implement

This paper describes the collaborative application of three theoretical models for supporting service planning (Hunter, 2006), programme planning (Chorpita et al, 2005a), and implementation (Meyers et al, 2012) to develop and implement a Resilience Practice Framework (RPF). Specifically, we (1) describe a theory of change framework (Hunter, 2006) to clarify the target for intervention and outcomes to be achieved; (2) describe a common elements approach (Chorpita et al, 2005a) to select evidence-informed practices; (3) describe the application of the Quality Implementation Framework (QIF) (Meyers et al, 2012) to implement an RPF; and lastly (4) present preliminary findings for early implementation efforts and future directions.

Clinician use of standardized assessments following a common elements psychotherapy training and consultation program.

Despite increasing emphasis on the implementation of evidence-based treatments in community service settings, little attention has been paid to supporting the use of evidence-based assessment (EBA) methods and processes, a parallel component of evidence-based practice. Standardized assessment (SA) tools represent a key aspect of EBA and are central to data-driven clinical decision making. The current study evaluated the impact of a statewide training and consultation program in a common elements approach to psychotherapy. Practitioner attitudes toward, skill applying, and use of SA tools across four time points (pre-training, post-training, post-consultation, and follow-up) were assessed. Results indicated early increases in positive SA attitudes, with more gradual increases in self-reported SA skill and use. Implications for supporting the sustained use of SA tools are discussed, including the use of measurement feedback systems, reminders, and SA-supportive supervision practices.

Parameters for Creating Culturally Sensitive CBT: Implementing CBT in Global Settings

The current article is a commentary on the article, “A Common Elements Approach for Adult Mental Health Problems in Low- and Middle-Income Countries,” which describes a form of transdiagnostic CBT and its implementation among a highly traumatized Burmese and Iraqi group. Murray et al.’s (this issue) article is one of several new studies indicating the efficacy of CBT in global contexts. In this commentary, we suggest a set of parameters to create culturally sensitive CBT in global settings in a way to maximize efficacy and effectiveness. When applicable, we will discuss ways in which these parameters are illustrated by Murray et al. in this pilot study. These parameters can be used more generally to design culturally sensitive CBT studies in global contexts and to evaluate such studies. Some examples of these parameters are culturally appropriate framing of CBT techniques, assessing and addressing key local complaints (e.g., somatic symptoms) and local catastrophic cognitions, and incorporating key local sources of recovery and resilience.

Common Elements of Adolescent Prevention Programs: Minimizing Burden While Maximizing Reach

A growing number of evidence-based youth prevention programs are available, but challenges related to dissemination and implementation limit their reach and impact. The current review identifies common elements across evidence-based prevention programs focused on the promotion of health-related outcomes in adolescents. We reviewed and coded descriptions of the programs for common practice and instructional elements. Problem-solving emerged as the most common practice element, followed by communication skills, and insight building. Psychoeducation, modeling, and role play emerged as the most common instructional elements. In light of significant comorbidity in poor outcomes for youth, and corresponding overlap in their underlying skills deficits, we propose that synthesizing the prevention literature using a common elements approach has the potential to yield novel information and inform prevention programming to minimize burden and maximize reach and impact for youth.

Translating the Common Elements Approach: Social Work's Experiences in Education, Practice, and Research

The expansion of the use of evidence-based practices (EBPs) in mental health services is well under way and social work seeks to further its appropriate implementation in both specialty and nonspecialty mental health settings. The common elements approach is now recognized as demonstrating promise for use in a range of settings. This article discusses the attractiveness of the common elements approach and describes several efforts to integrate its content into social work education and to disseminate this approach into the field. Then the article presents research initiatives regarding two areas of nonspecialty mental health practice with children and families: (a) engaging clients in mental health services and (b) preventing the need for out-of-home placement for youth. Finally, we consider the challenges of the common elements framework for social work education and practice and future directions for research.