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How is Research Support Defined?

Created on August 5, 2017. Last updated on December 5th, 2020 at 05:46 pm

As with all health care professionals, clinical child and adolescent psychologists are dedicated to offering the best level of care available by constantly testing and comparing how effectively various treatments work for a variety of child and adolescent mental health problems. Through this research, psychologists are looking to discover which treatment is likely to work best for each individual. The Society of Clinical Child and Adolescent Psychology uses a scale of one (most support) through five (lowest support).

Below is a summary of the criteria for each level. The research supporting each treatment listed on this website has been evaluated to determine how effective it is for each behavioral issue or mental disorder. For example, even though a therapy might be a Level One treatment for anxiety, it may not have as much evidence to show it works well for depression.

As new research becomes available, treatments may change levels, moving either up or down. will strive to keep its lists up to date.

Levels of Research Support for Therapy

Level One: Works Well; Well-established Treatments

Level One treatments have the strongest research support. To meet this high standard, these treatments must meet a variety of criteria. Above all, there must be at least two thorough scientific studies, such as large-scale randomized controlled trials, showing that the treatment is more effective in treating children or adolescents’ symptoms, compared to some other treatment or to something that people might believe is a treatment, like a pill placebo.

Level One treatments have been studied by independent teams working at different research settings. That is, the treatment must be one that works well for different scientists, not just the ones who developed the therapy.

Level Two: Works; Probably Efficacious Therapies

Level Two therapies have strong research support, too, but they may not have been tested by different or independent teams, like Level One therapies. It is also possible for a therapy to be considered Level Two if only one study shows the treatment is much more effective than a Level One therapy or if at least two studies show it is better than no treatment.

Level Three: Might Work; Possibly Efficacious Therapies

Level Three therapies could be called “promising therapies.” There may be one study showing that the treatment is better than no treatment, or there may be a number of smaller clinical studies without all of the appropriate procedural controls. Overall, confidence that a Level Three treatment works consistently is not as strong as it could be.

Level Four: Unknown/Untested; Experimental Therapies

Level Four therapies may be in use, but have not been studied carefully. Some would suggest that these treatments should be avoided until further evidence is available. However, for some child/adolescent symptoms or disorders with limited therapy options, a treatment at this level could be worth considering.

Level Five: Does Not Work/Tested But Did Not Work

Level Five therapies have been tested in well-designed studies and have not yet shown positive results. A Level Five treatment may either not be better than no treatment (or other comparison treatments) or else the treatment actually made symptoms or behaviors worse. While it is possible that new studies will show that a Level Five therapy works better in the future, a therapy currently listed as Level Five would not be a good treatment option.


Southam-Gerow, Michael A.; Prinstein, Mitchell J. 2014. Evidence Base Updates: The Evolution of the Evaluation of Psychological Treatments for Children and Adolescents. Journal of Clinical Child & Adolescent Psychology, 43(1), 1-6.

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Evidence-based Services Committee of Hawaii