An Examination of Modular Therapy for Tier 3 Student Support: Clinician Preferences and Impressions
In February 2025, Kelly Lojinger led a poster presentation at the annual convention of the National Association of School Psychologists in Seattle, WA. Her co-authors were Brandon K. Schultz and Mark D. Weist.
Introduction
•School-based behavioral health improves K-12 students’ overall well-being and academic success, but there are several barriers to effective delivery in those settings.
•The Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH-ADTC; Chorpita & Weisz, 2009) is a set of flexible, evidence-based treatments that can be used in schools (e.g., Chorpita et al., 2017; Weisz et al., 2012).
•The modular structure of the MATCH-ADTC allows clinicians to tailor treatment plans for each child based on their individual needs.
Current Study
•Six community-based therapists were recruited to provide intensive student supports, either using the MATCH-ADTC or treatment-as-usual (TAU), in 16 elementary schools randomly assigned to treatment conditions.
•Clinicians who provided the MATCH-ADTC received brief training and monthly super-vision with a university-based researcher.
•We then analyzed clinician data collected across both treatment paradigms.
Methods
•Over three years, 824 total therapy sessions were recorded for 131 fourth and fifth graders.
•Clinicians recorded their session goals and rated how well the student client appeared to respond to each.
•Client response was rated on a 1 to 5 Likert-type scale, where higher scores indicated a stronger response (e.g., 5 = client responded very positively).
Results
•"Problem Solving” (n = 52) and “Presenting a Positive Self” (n = 46) were the MATCH-ADTC modules most used (see Figure 1).
• TAU sessions mostly targeted emotion regulation, communication skills, and behavior change. Source materials like “Therapist Aid” were mentioned, but only rarely.
•MATCH-ADTC modules with the highest average client response were “Practicing” (M = 4.3, SD = 0.71), and “Wrap up Anxiety” (M = 4.1, SD = 0.62) (see Figure 2; sessions only used once, like “Learning About Anxiety-Parent,” are shaded and must be interpreted carefully).
• We compared clinician ratings of client response across the MATCH-ADTC, TAU, and a third set of sessions where MATCH-ADTC therapists used other services (i.e., “augmentation”). There was a significant difference across conditions, F(2, 840) = 24.71, p < .001. Planned contrasts revealed that any MATCH-ADTC sessions significantly outperformed TAU sessions, t(671.2) = 5.85, p < .001, d = .85, and that augmented MATCH-ADTC sessions significantly outperformed traditional MATCH-ADTC sessions, t(329.7) = -4.59, p <.001, d = .44.
Discussion
The MATCH-ADTC is a valuable tool for providing intensive, Tier 3 services in schools. In the current study, community-based clinicians attempted MATCH-ADTC sessions with limited outside support during a 3-year effectiveness trial. Clinicians applied modules in 294 total sessions. The most frequently used modules (e.g., Problem Solving, Positive Self) appeared easiest to adopt early in implementation and might represent early targets for training modular therapy with elementary school-age children.
Clinicians reported that the MATCH-ADTC modules were generally well-received by their clients. When compared to treatment-as-usual, MATCH-ADTC clinicians rated client response significantly stronger (d = .85). But interestingly, sessions where therapists augmented MATCH-ADTC treatment with other materials were rated even higher on average (d = .44). These results suggest that modular therapy is well-received as designed and provides an effective framework for clinicians to augment therapy when needed. In other words, modular therapy engages clients effectively, even when clinicians must “go off script.”
A limitation of the present study is that only permanent products and clinician self-reports were used to assess treatment fidelity, so it is unclear whether MATCH-ADTC was truly implemented as intended. Still, our results provide compelling data to suggest that clinicians believe clients respond better to modular therapy (and occasional augmentations to modular therapy) than treatment-as-usual.
References
