Efficacy of measurement-based care (MBC) in routine child and youth behavioral therapy: A pragmatic randomized controlled trial

Objective: This pragmatic randomized trial evaluated a low-frequency measurement-based care (MBC) approach in children and youth. Method: In the modified intention-to-treat sample (mITT), 317 children (6-10) and youth (11-17) were randomized to behavioral therapy with or without MBC; 169 completed the trial per protocol (PP). Outcomes were assessed by masked raters, therapists, caregivers, and youth. Results: Average MBC participation ranged from 69% to 87% across informants, while therapists discussed the report at least once in only 29.3% of cases. In the mITT analysis, masked ratings of total symptoms (SFSS-I) showed no effect, d = 0.00, 95% CI [-0.22, 0.22], while caregiver-rated externalizing symptoms (FBB-SCREEN) showed a small reduction, d = -0.17, [-0.33, -0.01]. In the PP analysis, masked ratings (SFSS-I) remained nonsignificant, d = -0.29, [-0.59, 0.01], but caregiver ratings showed significant reductions in externalizing (FBB-SCREEN), d = -0.29, [-0.53, -0.05], and internalizing symptoms (CBCL), d = -0.32, [-0.61, -0.03]. Conclusions: Low-frequency MBC may offer practical advantages for child and youth therapy, such as good participation, but its efficacy remained insufficient, likely reflecting implementation challenges. Differences between caregiver and masked outcomes may indicate a risk of overestimating treatment effects when assessments are unblinded.Trial registration: German Clinical Trials Register identifier: DRKS00016737.