5 - (SYM 30) Primary Outcomes from the Community Study of Outcome Monitoring for Emotional Disorders in Teens: A Randomized Trial of a Transdiagnostic Treatment and a Measurement Feedback System in Community Clinics

Background: Emotional disorders are the most prevalent psychiatric disorders in youth. Many single-domain protocols have been developed to treatment emotional disorders in youth, but few are routinely used in community mental health centers (CMHCs). Clinicians delivering care in CMHCs may need to deviate from single-domain protocols to meet the needs of their clients, who often present with comorbidities. Transdiagnostic interventions allow for a focus on key mechanisms of change across emotional disorders and clinician flexibility to target multiple problem areas simultaneously. This talk will describe primary outcomes and lessons learned from the Community Study of Outcome Monitoring for Emotional Disorders in Teens (COMET), a two-site randomized controlled effectiveness trial of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) and a measurement feedback system in CMHCs. 

Method: Participants were 196 youth (65% female, 61% White, 59% Non-Hispanic) randomized to receive treatment as usual (TAU; n = 68), TAU plus a measurement and feedback system (TAU+; n = 60), or UP-A plus a measurement and feedback system (UP-A; n = 68) across 19 CMHCs in South Florida and Connecticut. Treatment response was measured at weeks 16 and 28 post-enrollment using the independent evaluator-rated Clinical Global Impression – Improvement Scale (CGI-I; Guy, 2000) and defined as a CGI-I score of 1, 2, or 3 (“Minimally improved” to “Very much improved”). Child- and parent-report measures of internalizing symptoms and functioning were also collected. Analyses were conducted using multilevel modeling.

Results: Participants in the UP-A (Response rate = 88.9%; b = 1.20, t(257) = 1.99, p = .048, OR = 3.32) and TAU+ (Response rate = 90.0%; b = 1.21, t(257) = 1.94, p = .054, OR = 3.34) conditions exhibited higher rates of treatment response than those in the TAU condition (Response rate = 75.5%) but did not differ from each other. Child-reported symptoms decreased significantly faster in the UP-A (b = -.07, t(461) = -2.05, p =.041, d = .19) and TAU+ (b = -.08, t(456) = -2.11, p = .035, d = .20) conditions compared to the TAU condition. Parent-reported symptom change did not differ across conditions.

Discussion: Findings support the effectiveness of the UP-A and measurement feedback compared to TAU delivered in CMHCs, although further adaptations are likely necessary to maximize clinical benefit. Future directions for UP-A intervention tailoring, clinician training, and community-engaged research will be discussed.