Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 2 appraisals
PloS one
Optimizing treatment for depressed parents of children with emotional and behavioral disorders: A multi-site feasibility trial.
BACKGROUND: Behavioral parent training (BPT) programs are effective for reducing disruptive behavior of many children with emotional and behavioral disorders (EBD) and improving skills and competencies of their parents. However, these interventions are not sufficiently effective for parents who themselves have depression. This study assessed the feasibility of the Addressing Depression and Positive Parenting Techniques (ADAPT) Program-a novel BPT that includes aspects of cognitive behavioral therapy and dialectical behavior therapy. We identified whether recruitment was possible, attendance was acceptable, participants were satisfied, and facilitators adhered to the protocol. Additionally, we measured trends in changes in parent and child outcomes with intervention. METHODS: Participants were 28 parents and their children with EBD, referred to two hospital-based clinics. Parents were eligible if they (1) had a child aged 6-10 experiencing emotional and behavioral difficulties and (2) were experiencing elevated depressive symptoms. ADAPT took place virtually over 10 weeks. Participants completed measures before, weekly and after treatment. Clinicians recorded attendance and completed weekly treatment fidelity checklists. RESULTS: We found that recruitment was possible, the intervention showed high parental satisfaction, and facilitators reported high program fidelity. Further, secondary outcome measures showed evidence of sensitivity to change in the intended direction. CONCLUSION: Given that a priori progression criteria were met and we found preliminary indication of efficacy, we conclude that an RCT of ADAPT to determine efficacy is warranted.
11 July 2026
Read appraisal →Psychological medicine
The effect of managed transition on the proportion of young people transitioning from CAMHS to AMHS: Analysis of the Milestone Cluster Randomised Clinical Trial
BACKGROUND: Transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is poorly managed, with discontinuity of care commonplace, leading to poorer outcomes, while evidence-based interventions to improve transition are scarce. This study is a secondary analysis of the MILESTONE trial, aiming to determine whether managed transition increases the proportion of young people who appropriately transition from CAMHS to AMHS. METHODS: The MILESTONE trial was a multicenter, two-arm, cluster-randomized controlled trial across eight countries at 40 CAMHS sites to compare usual care (UC) to managed transition (MT). MT consisted of training, identification, and assessment of transition readiness and appropriateness. Eligible participants were receiving CAMHS care, IQ ⩾ 70 and within 1 year of their service transition boundary. CAMHS sites were randomized 2:1 between UC and MT. The main outcome was whether participants were receiving care from AMHS at 15 months follow up. RESULTS: The MILESTONE study included 793 participants, 552 receiving UC and 241 receiving MT. In the MT group, 24.9% transitioned to AMHS at 15 months compared to 14.2% in the UC group (p = 0.002), and appropriate transitions (in those with a need for transition at baseline or ongoing clinical need at 15 months) were 32.3% in the MT group compared to 16.4% in the UC group (p < 0.001). CONCLUSIONS: A higher proportion of the MT group transitioned to AMHS at 15 months, and there was a higher proportion of appropriate transitions compared to UC. Clinicians and services should consider the incorporation of MT into routine clinical care.
7 Apr 2026
Read appraisal →