Identifying common elements of evidence-based psychosocial treatments for children's disruptive behavior problems

Objective: Almost all of the efforts to study and implement evidence-based practice (EBP) have used individual treatments as the unit of analysis. A complementary approach using aggregated common elements of multiple individual evidence-based treatment programs has been introduced. The purpose of this article is to describe a new method for identifying common elements of EBP and to present common elements resulting from a systematic review of interventions forchildren with disruptive behavior problems and their parents. Method: We identified eight individual treatment programs with established efficacy for children ages 4 to 13 with disruptive behavior problems, reviewed all of the treatment materials thoroughly, identified core elements of each treatment, and determined which elements were common to at least half of the programs. The validity of these common core elements was confirmed through a survey of national experts using a modified Delphi technique. Results: We identified 21 treatment elements that were common to multiple evidence-based treatment programs. These included therapeutic content (e.g., principles of positive reinforcement, problem-solving skills training), treatment techniques (e.g., role-playing, assigning homework), aspects of the working alliance, and other parameters such as treatment duration. Conclusions: Identification of common core elements of EBP has important implications for efforts to characterize practice, as well as therapist training and implementation of EBP in community-based service settings. Therapist training and ongoing supervision that builds on common elements of EBP could potentially improve the effectiveness of care overall. It could also build a strong foundation for targeted individual treatment implementation efforts by enhancing therapists' skills and attitudes about EBP.