Personalizing Youth Psychotherapy: A Scoping Review of Decision-Making in Modular Treatments

• Published in: Clinical psychology (New York, N.Y.) N.Y.), 2023-03, Vol.30 (1), p.45-62
• Main Authors: Venturo-Conerly, Katherine E., Reynolds, Rachel, Clark, Malia, Fitzpatrick, Olivia M., Weisz, John R.
• Format: Article
• Language: English
• Subjects: Adolescent Psychotherapy; Child Psychotherapy; Clinical Judgment (Not Diagnosis); Decision Making; Human; Precision Medicine; Psychotherapy
• ISSN: 0969-5893; 1468-2850
• DOI: 10.1037/cps0000130

Modular youth psychotherapies are increasingly popular, in part because their flexibility facilitates personalizing, but the clinician decision-making required can be complex. We investigated decision guidance in 20 modular youth psychotherapies, described in 67 articles identified via a systematic search. Decision guidance was limited. Clinical judgment was recommended in all therapies; 95% recommended using baseline assessment, 65% measurement-based care, and 25% prior research. Most commonly, guidance involved module descriptions (90%); some therapies provided decision flow diagrams (35%); one provided an online decision tool. Only 40% proposed seeking client input. Despite evidence that statistical models outperform clinical judgment, no modular psychotherapy used statistical models. Maximizing therapy effectiveness may require building decision supports that incorporate client perspectives and balance clinical judgment with statistical methods. Public Health Significance Statement Modular youth psychotherapies may offer advantages for clinical practice because of their potential to be personalized to fit individual youths; however, the clinician decision-making required for such personalizing can be complex. In this scoping review, we gathered relevant protocols of modular psychotherapies published to date, finding that decision-making in modular psychotherapies often relies on clinical judgments, and rarely involves input from clients, statistical models, or algorithms. Future research focused on associations between decision-making procedures and clinical outcomes may improve the implementation and effectiveness of modular youth psychotherapies in clinical practice.