Personalizing Youth Psychotherapy: A Scoping Review of Decision-Making in Modular Treatments

Modular youth psychotherapies are increasingly popular, in part because their flexibility facilitates personalizing, but the clinician decision-making required can be complex. We investigated decision guidance in 20 modular youth psychotherapies, described in 67 articles identified via a systematic search. Decision guidance was limited. Clinical judgment was recommended in all therapies; 95% recommended using baseline assessment, 65% measurement-based care, and 25% prior research. Most commonly, guidance involved module descriptions (90%); some therapies provided decision flow diagrams (35%); one provided an online decision tool. Only 40% proposed seeking client input. Despite evidence that statistical models outperform clinical judgment, no modular psychotherapy used statistical models. Maximizing therapy effectiveness may require building decision supports that incorporate client perspectives and balance clinical judgment with statistical methods.