Academic journal article Journal of Cognitive Psychotherapy

Empirically Supported Treatments: Dissemination Practices in Impoverished Regions

Academic journal article Journal of Cognitive Psychotherapy

Empirically Supported Treatments: Dissemination Practices in Impoverished Regions

Article excerpt

A growing understanding of the implications of childhood psychopathology has driven the dissemination of empirically supported treatments (ESTs). This has not been the case in countries with high rates of poverty and violence-where the need for ESTs is fundamental. In this article, we examined the current status of child psychopathology and mental health services for children in El Salvador to explore key factors that can improve dissemination of ESTs in middle- and low-income countries. In El Salvador, children are constantly exposed to risk factors related to childhood disorders (e.g., violence), and there is an increase in the demand for mental health services for this population. However, a lack of a guiding policy and formal training has led to few psychologists using ESTs. A scientist-practitioner model to guide formal education and training of mental health providers would be the first step to improving the dissemination of ESTs in El Salvador.

Keywords: empirically supported treatment; dissemination; El Salvador; childhood; psychopathology

The effort to provide effective mental health treatments has driven the field of psychotherapies for decades. Stemming from the evidence-based movement that started in the United Kingdom (Chambless & Ollendick, 2001), one of the first official attempts was carried out by the American Psychological Association's Division 12 Task Force on Promotion and Dissemination of Psychological Procedures established in 1995. Their work (e.g., Chambless, 1996; Chambless & Hollon, 1998) promoted the dissemination of empirically supported treatments (ESTs) through a three-pronged approach. First, it promoted the establishment of concrete guidelines to evaluate if an intervention is empirically supported; second, it advocated the importance of scientifically guided knowledge in clinical settings; and third, it encouraged EST training for mental health practitioners.

Almost two decades later, research on ESTs for different childhood psychopathologies has significantly advanced. Progress in this field has put forth new programs and specific techniques for specific childhood problems, increased knowledge about applicability in culturally diverse settings, and highlighted moderators of treatment outcome (Weisz & Kazdin, 2010). Important steps are continuously being taken to promote empirically based treatments. However, advancements in this field have taken place primarily in the United States, Australia, and Europe. Dissemination of evidence-based practices has not reached emerging regions where it is significantly needed. Countries where children are exposed to a vast range of risk factors associated with childhood psychopathologies, especially violence and poverty, lag behind in the application of ESTs.

El Salvador, located in Central America, is part of the developing countries situated in the lower middle-income range according to the 2010 World Bank report (data from the World Health Organization [WHO], 2011). The high rates of violence and poverty expose a large percentage of El Salvadorian children to a wide range of risk factors associated with childhood mental health disorders (e.g., domestic violence, abuse) needing the dissemination of ESTs. Extensive evidence has accumulated indicating the effectiveness of diverse psychotherapeutic interventions in improving mental health outcomes for children and adolescents (Ollendick & King, 2004; Weisz & Kazdin, 2010); now, the challenge lies in those interventions being implemented, especially in at-risk areas such as El Salvador.

In the area of mental health services for children, the need for empirically based interventions not only becomes evident but also becomes a fundamental necessity. Not only is there a high rate of mental health problems that warrant immediate care, but also the lack of resources, policies, and support for families and children create a demand for delivery of effective interventions accessible to most of the population. …

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