Therapeutic approaches for young people with complex needs
Many treatments targeting particular diagnosed disorders or discrete conditions affecting children and adolescents have been developed, tested and demonstrated efficacy in randomised controlled trials. Results have been summarised in numerous meta-analyses and systematic reviews. These types of treatments will be referred to as Empirically Supported Treatments (ESTs) (McHugh, Murray, & Barlow, 2009; Mitchell, 2011).
Young people receiving services for problems with alcohol and other drugs (AOD) often experience high rates of other psychosocial problems. These include mental health problems, involvement in the justice system, homelessness, exposure to trauma, family disturbance and limited opportunities for work or further education. This complexity has implications for case formulation and the design and delivery of evidence-based therapeutic interventions.
Very little research has explicitly focused on developing and evaluating interventions for young people experiencing more than one major life difficulty, or with multiple and complex needs (Hawkins, 2009; Mitchell, 2012). However, there are several therapeutic approaches that have demonstrated effectiveness in improving more than one condition or problem (e.g. AOD and mental health problems such as depression or anxiety), and in recent years there has been a trend towards developing multidimensional interventions that integrate components drawn from several different evidence-based approaches.
Based largely on these considerations Bruun and Mitchell (2012) identified seven therapeutic approaches that have considerable applicability in providing psychosocial interventions likely to be effective for assisting the population of young people with complex psychosocial needs.
The practice principles embodied in these approaches are highly consistent with value-based practice principles and ‘characteristics of effective services and programs’ widely endorsed in the practice wisdom literature that underpins the approach to service provision in many youth-focused AOD services in Australia.
There is also substantial evidence for the effectiveness of MI, CBT, ACRA, MDFT and DBT in achieving a variety of outcomes relevant to young people with multiple and complex needs (Bruun & Mitchell, 2012). Theoretical change processes specified in SFT and NT address some of the same outcome domains, as well as various needs not addressed by other approaches.
New approaches such as Acceptance and Commitment Therapy (ACT) and Cognitive Analytic Therapy (CAT) could also be added to this list in the future.