CEBC Perspective on the Common Elements Approach

There has been an increasing interest in the concept of a common elements approach within child welfare and related fields. The common elements approach is the concept of identifying specific techniques or components that overlap across multiple evidence-based practices (EBPs) for a specific problem area (e.g., parent training, disruptive behavior disorders, etc.). For example, several of the programs that are in the CEBC’s Parent Training topic area contain psychoeducation, time out, praise, and positive reinforcement as essential elements; each of these would be a common element (Chorpita 2005, 2007). In place of using a specific manualized intervention in its entirety, these common elements are taken together and used as an intervention.

There are several advantages cited by those who are supportive of this framework which make this approach seem very useful to those in the field. First of all, there is greater flexibility for serving a variety of client populations, many of whom will have complex needs and co-morbidities. Secondly, there are financial advantages for an agency who can train their workforce in a common elements approach rather than training them in multiple EBPs to meet the needs of the client populations that they serve. Finally, there is less complexity in having a workforce trained in using a common elements approach versus in multiple EBPs, which all may require different paperwork, fidelity monitoring, and oversight (Chorpita 2007).

There are, however, several concerns that the CEBC has with the common elements approach. First, and foremost, is the lack of research on the common elements approach: there have been no randomized controlled trials comparing the common elements approach to an evidence-based practice delivered in its entirety. Second, the evidence for the effectiveness of an individual common element is limited – it is not known how much impact an individual element has, as studies have typically focused on interventions as a whole. Strong evidence for a component would require conducting what researchers call a dismantling study and those are rarely done. Finally, the common elements approach relies on the existence of several evidence-based practices in the area of interest that can be examined in detail (Chorpita, 2005). In areas where these is very little or no research and no EBPs, it would be inappropriate to pull common elements together from unproven programs.

Research on the common elements approach should continue, as the approach has potential merit, but it will be important to clarify how common elements are identified and how individual elements are selected for use with an individual client. In addition, the relationship between EBPs and common elements needs to be clarified. For example, should therapists be trained and certified in any specific EBPs or is training on only the common elements sufficient? Finally, the content of the element needs to be clarified. For example, two therapists may deliver psychoeducation, but in differing ways with varying effectiveness.

In summary, the research evidence for the common elements approach is extremely limited at this time and has included no rigorously designed research. The CEBC encourages further examination of the common elements approach, with a focus on evidence of outcomes and effectiveness, before widespread use is initiated.

References:

Chorpita, B. F., Becker, K. D., Daleiden, E. L., & Hamilton, J. D. (2007). Understanding the common elements of evidence-based practice: Misconceptions and clinical examples. Journal of the American Academy of Child & Adolescent Psychiatry, 46(5), 647-652.

Chorpita, B. F., Daleiden, E. L., & Weisz, J. R. (2005). Identifying and selecting the common elements of evidence based interventions: A distillation and matching model. Mental Health Services Research, 7(1), 5-20.

Other articles on the subject:

Barth, R. P., Lee, B. R., Lindsey, M. A., Collins, K. S., Strieder, F., Chorpita, B. F., ... & Sparks, J. A. (2012). Evidence-based practice at a crossroads: The timely emergence of common elements and common factors. Research on Social Work Practice, 22(1), 108-119.

Chorpita, B. F., Rotheram-Borus, M. J., Daleiden, E. L., Bernstein, A., Cromley, T., Swendeman, D. & Regan, J. (2011). The old solutions are the new problem: How do we better use what we already know about reducing the burden of mental illness?. Perspectives on Psychological Science, 6(5), 493-497.

Garland, A. F., Hawley, K. M., Brookman-Frazee, L., & Hurlburt, M. S. (2008). Identifying common elements of evidence-based psychosocial treatments for children's disruptive behavior problems. Journal of the American Academy of Child & Adolescent Psychiatry, 47(5), 505-514.