Testing child STEPS in school-based mental health care: Cluster-randomized controlled effectiveness trial in five...

More youth mental health care in the United States is provided in schools than any other setting. So, there is a need for evidence-based psychotherapies that can work well with students in those sometimes complex environments. Transdiagnostic modular therapies may help, given their flexibility and capacity to address diverse youth disorders and problems.

We tested this possibility by conducting a school-based cluster-randomized controlled trial of Child STEPs, an intervention that combines the Modular Approach to Therapy for Children with consultation and measurement-based care. One hundred forty-two elementary and middle school students (Mage = 9.78, SD = 1.76, range 7-14; 39% female; 59% White, 18% multiracial, 9% Black, 6% Asian, 4% Hispanic, 4% another race/ethnicity) from five urban and suburban school districts were treated by 57 school counselors who had been randomized to STEPs or usual counseling (UC).

The full sample improved significantly across multiple multi-informant mental health measures-administered at baseline, during treatment, at posttreatment, and 6-month follow-up. STEPs counselors showed strong Modular Approach to Therapy for Children fidelity (coded from session recordings) and strong endorsement of Modular Approach to Therapy for Children effectiveness. However, there was no significant difference between STEPs and UC on any mental health outcome, and STEPs students showed poorer school engagement during treatment than UC students.

STEPs did not outperform UC, despite strong STEPs fidelity by counselors; future research may test whether this finding is robust or might be altered by adapting evidence-based modular treatment for the school context. (PsycInfo Database Record (c) 2026 APA, all rights reserved).