Common Practice Elements in Treatment Programs for Adolescents with Externalizing and Internalizing Problems: A Meta-Analysis

There is a pressing need for effective interventions targeting mental disorders for service-involved youth across child welfare, correctional and mental health residential settings. Identifying effective common practice elements (CPEs) is a promising direction toward developing effective, flexible, and feasible therapeutic interventions. The aims of this study were: 1) to identify CPEs in treatment programs for adolescents with internalizing and/or externalizing disorders across residential settings, 2) to identify which CPEs are present in effective versus all trials, and 3) to estimate whether the presence of each CPE is associated with treatment effects. A systematic search identified 24 trials of programs targeting adolescent internalizing and/or externalizing symptoms, yielding 148 effect estimates. Discrete practices were coded into CPE categories across effective trials and the full sample. Eleven CPEs were identified and employed as moderators in three-level meta-analyses. We found large significant moderator effects of two elements on externalizing symptoms: Emotion recognition and differentiation, and Psychoeducation. No CPE was significantly related to effects on internalizing outcomes. The results illustrate the difference between CPE frequency and association with effect, favoring a combination of the two approaches. Emotion recognition and differentiation, and Psychoeducation should be prioritized in novel interventions targeting adolescent externalizing behavior in residential settings.