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The Death of Treatment as Usual: An Excellent First Step on a Long Road


Address correspondence to Leonard Bickman, Vanderbilt University, 1207 18th Ave. South, Nashville, TN 37212. E-mail:


The failure of system reforms to affect child and family outcomes and the lack of positive findings concerning treatment as usual has led to pressure to reform treatment in the community through the adoption of evidence-based treatments. While this is generally a positive direction for the future, reformers should also consider the quality of evidence supporting these treatments and the dependence on traditional diagnostic approaches as limitations to this approach. Moreover, reformers should recognize the importance of learning from clinicians and consumers, the inclusion of a common factors approach and the critical role of measurement in the reform process.