Managing and Adapting Practice: A System for Applying Evidence in Clinical Care with Youth and Families

Concerns about the gap between service quality in mental health systems and the growing literature on scientifically tested treatment approaches has led to multiple policy and practice initiatives calling for greater use of empirically supported interventions (ESIs) in children’s mental health systems. Despite the demonstrated efficacy of these approaches, some concerns remain about the current suitability of ESIs as a single strategy for improving service system quality. Issues raised include (a) the appropriateness of some interventions for individualized care or adaptation in response to emergent events, and (b) the ability for ESIs collectively to yield a comprehensive service array for youth and families. The current paper thus outlines one strategy to complement and extend that work, through a system for organizing and coordinating currently available ESIs as well as for building and adjusting individualized, evidence-informed plans when needed, using dedicated tools to inform treatment design, adaptation, and evaluation in real time. A case example is presented, and implications for treatment and research are discussed.