Review
Little Treatments, Promising Effects? Meta-Analysis of Single-Session Interventions for Youth Psychiatric Problems

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Objective

Despite progress in the development of evidence-based interventions for youth psychiatric problems, up to 75% of youths with mental health needs never receive services, and early dropout is common among those who do. If effective, then single-session interventions (SSIs) for youth psychiatric problems could increase the accessibility, scalability, completion rates, and cost-effectiveness of youth mental health services. This study assessed the effects of SSIs for youth psychiatric problems.

Method

Using robust variance estimation to address effect size (ES) dependency, findings from 50 randomized-controlled trials (10,508 youths) were synthesized.

Results

Mean postintervention ES showed a Hedges g value equal to 0.32; the probability that a youth receiving SSI would fare better than a control-group youth was 58%. Effects varied by several moderators, including target problem: ESs were largest for anxiety (0.56) and conduct problems (0.54) and weakest for substance abuse (0.08; targeted in >33% of studies). Other problems yielded numerically promising but nonsignificant ESs (e.g., 0.21 for depression), potentially from low representation across trials. ESs differed across control conditions, with larger ESs for studies with no treatment (0.41) versus active controls (0.14); developmental periods, with greater ESs for children (0.42) than adolescents (0.19); intervention types, with largest ESs for youth-focused cognitive-behavioral approaches (0.74); and follow-up lengths, with smaller ESs for follow-ups exceeding 13 weeks. ESs did not differ for self- versus therapist-administered interventions or for youths with diagnosable versus subclinical problems.

Conclusion

Findings support the promise of SSIs for certain youth psychiatric problems and the need to clarify how, to what degree, and for whom SSIs effect lasting change.

Section snippets

Search Strategy

We conducted searches in multiple bibliographic databases (PsychINFO, Eric, PubMed, ScienceDirect, Medline, and ProQuest) to identify peer-reviewed RCTs and unpublished dissertations describing SSIs for youth mental health problems (cutoff December 31, 2015). Search terms included single-session, one-session, treatment, prevention, child, adolescent, and pediatric. We also checked references of earlier narrative reviews and contacted researchers conducting work in this domain to maximize

Study Selection and Inclusion

Of the 2,097 examined abstracts (1,993 after removal of duplicate records), 210 full-text articles were retrieved for further consideration. Of these, 159 were excluded (Figure 1). Fifty-one studies met the inclusion criteria, and 50 (47 published articles and 3 dissertations) were included in the analyses after the exclusion of 1 outlier, as described earlier.

Characteristics of Included Studies

Table S1 (available online) presents additional details.

The 50 trials included a total of 10,508 participants, and each had an average

Discussion

We conducted the first comprehensive, systematic meta-analysis, to our knowledge, evaluating SSIs for youth psychiatric problems. Across 50 RCTs representing 10,508 youths, SSIs demonstrated a significant beneficial effect in the small-to-medium range (g = 0.32). Effects were consistent regardless of youth problem severity and diagnostic status, suggesting the effectiveness of SSIs in youths with psychiatric disorders and subclinical problems. Practical implications of these results could be

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    The authors acknowledge Marisol Consuegra, Joshua Insler, and Eun Youb Lee, all undergraduates, of Tufts University; Elise Garden, undergraduate, and Valerie Woxholdt, MA, of Harvard University; and Manaswi Kashyap, undergraduate, of Wellesley College, for their assistance with study identification and meta-analytic coding.

    Disclosure: Dr. Weisz has received grant and research support from the Annie E. Casey Foundation, the Norlien Foundation, the MacArthur Foundation, the National Institute of Mental Health, the Connecticut Health and Development Institute, and the Institute of Education Science, US Department of Education. He has received royalties from books published by Oxford University Press, Practicewise LLC, Cambridge University Press, and Guilford Press. He has served as a consultant to the Center for Child and Adolescent Behavioral Development in Norway and the University of Auckland, New Zealand. Ms. Schleider has received grant and research support from the National Institute of Mental Health, the American Psychological Foundation, and the Center on the Developing Child at Harvard University.

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