51
|
Garland AF, Bickman L, Chorpita BF. Change what? Identifying quality improvement targets by investigating usual mental health care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2010; 37:15-26. [PMID: 20177769 PMCID: PMC2874058 DOI: 10.1007/s10488-010-0279-y] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Efforts to improve community-based children’s mental health care should be based on valid information about effective practices and current routine practices. Emerging research on routine care practices and outcomes has identified discrepancies between evidence-based practices and “usual care.” These discrepancies highlight potentially potent quality improvement interventions. This article reviews existing research on routine or “usual care” practice, identifies strengths and weaknesses in routine psychotherapeutic care, as well as gaps in knowledge, and proposes quality improvement recommendations based on existing data to improve the effectiveness of children’s mental health care. The two broad recommendations for bridging the research-practice gap are to implement valid, feasible measurement feedback systems and clinician training in common elements of evidence-based practice.
Collapse
Affiliation(s)
- Ann F Garland
- University of California-San Diego, 3020 Children's Way, San Diego, CA, 92123, USA.
| | | | | |
Collapse
|
52
|
Longitudinal predictors of youth functional improvement in a public mental health system. J Behav Health Serv Res 2009; 37:350-62. [PMID: 19277868 DOI: 10.1007/s11414-009-9172-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 02/07/2009] [Indexed: 10/21/2022]
Abstract
The present study examined youth characteristics that predict level of impairment at entry into a system of care and rate of improvement over the course of service provision. Youth characteristics studied included gender, age, specific diagnostic categories, and comorbidity. A total of 2,171 youth served in a state-wide public mental health system were included in the study. Hierarchical linear modeling was used to analyze longitudinal data derived from quarterly ratings of functional status. Gender had no relationship to initial level of impairment or rate of improvement. Older youth, those with disruptive behavior disorders, and those with more than one DSM diagnosis were more impaired at system entry. Those with attentional disorders began services less impaired. Older youth improved at faster rates. Youth with a disruptive behavior disorder diagnosis improved at slower rates. Neither comorbidity nor the presence of a mood or attentional disorder affected the rate of improvement. Both researchers and systems of care developers should consider these patterns in their future work.
Collapse
|
53
|
Bearsley-Smith C, Sellick K, Chesters J, Francis K. Treatment content in child and adolescent mental health services: development of the treatment recording sheet. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2008; 35:423-35. [PMID: 18679789 DOI: 10.1007/s10488-008-0184-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 07/02/2008] [Indexed: 11/29/2022]
Abstract
This paper presents a clinician self-report measure developed to record the specific components of treatment used with adolescents attending a Child and Adolescent Mental Health Service (CAMHS). Using action research methodology, 18 clinicians attended up to five facilitated discussion groups during 2006 to discuss the planned implementation of a clinical trial. The clinicians helped adapt a checklist for recording treatment strategies applied in CAMHS with adolescents. The sessions were audio-taped and transcribed for thematic analysis. The final treatment recording checklist is presented. The clinicians reported the instrument was helpful for recording the content of their interventions and understanding their colleagues practice.
Collapse
Affiliation(s)
- Cate Bearsley-Smith
- School of Psychology, Psychiatry and Psychological Medicine, C/O Gippsland Regional Clinical School, Monash University, P.O. Box 424, Traralgon, VIC 3844, Australia.
| | | | | | | | | |
Collapse
|
56
|
Driving with roadmaps and dashboards: using information resources to structure the decision models in service organizations. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2007; 35:114-23. [PMID: 17987376 DOI: 10.1007/s10488-007-0151-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 10/23/2007] [Indexed: 10/22/2022]
Abstract
This paper illustrates the application of design principles for tools that structure clinical decision-making. If the effort to implement evidence-based practices in community services organizations is to be effective, attention must be paid to the decision-making context in which such treatments are delivered. Clinical research trials commonly occur in an environment characterized by structured decision making and expert supports. Technology has great potential to serve mental health organizations by supporting these potentially important contextual features of the research environment, through organization and reporting of clinical data into interpretable information to support decisions and anchor decision-making procedures. This article describes one example of a behavioral health reporting system designed to facilitate clinical and administrative use of evidence-based practices. The design processes underlying this system-mapping of decision points and distillation of performance information at the individual, caseload, and organizational levels-can be implemented to support clinical practice in a wide variety of settings.
Collapse
|
57
|
March JS, Szatmari P, Bukstein O, Chrisman A, Kondo D, Hamilton JD, Kremer CME, Kratochvil CJ. AACAP 2005 Research Forum: speeding the adoption of evidence-based practice in pediatric psychiatry. J Am Acad Child Adolesc Psychiatry 2007; 46:1098-1110. [PMID: 17712233 DOI: 10.1097/chi.0b013e318074eb48] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES At the 2005 Annual Meeting of the American Academy of Child and Adolescent Psychiatry (AACAP), the Academy's Workgroup on Research conducted a Research Forum entitled "Increasing Research Literacy Through the Adoption of Evidence-Based Practice (EBP) in Pediatric Psychiatry." METHOD Forum participants focused on speeding the adoption of EBP across five areas: EBP as the preferred heuristic for teaching research literacy, use of EBP in training programs, dissemination of EBP in clinical practice, EBP in partnership with industry, and EBP as a framework for developing practice guidelines. RESULTS EBP provides an easy-to-understand method for accessing and evaluating the research literature and then applying this information to decisions about patient care. Although EBP has been gaining greater visibility in pediatric psychiatry, it is far from the preferred heuristic. To move the field toward fully embracing EBP will require greater understanding of what EBP is (and is not), educating mental health professionals in EBP skills, access to EBP resources, and a commitment to apply EBP to the conceptualization and design of research protocols and practice guidelines. CONCLUSIONS Pediatric psychiatry would benefit from a principled commitment to follow other areas of medicine in adopting EBP.
Collapse
Affiliation(s)
- John S March
- Drs. March, Chrisman, and Kondo are with the Department of Psychiatry, Duke University Medical Center, Durham, NC; Dr. Szatmari is with the Department of Psychiatry at McMaster University, Hamilton, Ontario; Canada; Dr. Bukstein is with Western Psychiatric Institute and Clinic, University of Pittsburgh; Dr. Hamilton is with The Permanente Medical Group of California; Dr. Kremer is with Pfizer, Inc.; Dr. Kratochvil is with the Department of Psychiatry, University of Nebraska Medical Center, Omaha..
| | - Peter Szatmari
- Drs. March, Chrisman, and Kondo are with the Department of Psychiatry, Duke University Medical Center, Durham, NC; Dr. Szatmari is with the Department of Psychiatry at McMaster University, Hamilton, Ontario; Canada; Dr. Bukstein is with Western Psychiatric Institute and Clinic, University of Pittsburgh; Dr. Hamilton is with The Permanente Medical Group of California; Dr. Kremer is with Pfizer, Inc.; Dr. Kratochvil is with the Department of Psychiatry, University of Nebraska Medical Center, Omaha
| | - Oscar Bukstein
- Drs. March, Chrisman, and Kondo are with the Department of Psychiatry, Duke University Medical Center, Durham, NC; Dr. Szatmari is with the Department of Psychiatry at McMaster University, Hamilton, Ontario; Canada; Dr. Bukstein is with Western Psychiatric Institute and Clinic, University of Pittsburgh; Dr. Hamilton is with The Permanente Medical Group of California; Dr. Kremer is with Pfizer, Inc.; Dr. Kratochvil is with the Department of Psychiatry, University of Nebraska Medical Center, Omaha
| | - Allan Chrisman
- Drs. March, Chrisman, and Kondo are with the Department of Psychiatry, Duke University Medical Center, Durham, NC; Dr. Szatmari is with the Department of Psychiatry at McMaster University, Hamilton, Ontario; Canada; Dr. Bukstein is with Western Psychiatric Institute and Clinic, University of Pittsburgh; Dr. Hamilton is with The Permanente Medical Group of California; Dr. Kremer is with Pfizer, Inc.; Dr. Kratochvil is with the Department of Psychiatry, University of Nebraska Medical Center, Omaha
| | - Douglas Kondo
- Drs. March, Chrisman, and Kondo are with the Department of Psychiatry, Duke University Medical Center, Durham, NC; Dr. Szatmari is with the Department of Psychiatry at McMaster University, Hamilton, Ontario; Canada; Dr. Bukstein is with Western Psychiatric Institute and Clinic, University of Pittsburgh; Dr. Hamilton is with The Permanente Medical Group of California; Dr. Kremer is with Pfizer, Inc.; Dr. Kratochvil is with the Department of Psychiatry, University of Nebraska Medical Center, Omaha
| | - John D Hamilton
- Drs. March, Chrisman, and Kondo are with the Department of Psychiatry, Duke University Medical Center, Durham, NC; Dr. Szatmari is with the Department of Psychiatry at McMaster University, Hamilton, Ontario; Canada; Dr. Bukstein is with Western Psychiatric Institute and Clinic, University of Pittsburgh; Dr. Hamilton is with The Permanente Medical Group of California; Dr. Kremer is with Pfizer, Inc.; Dr. Kratochvil is with the Department of Psychiatry, University of Nebraska Medical Center, Omaha
| | - Charlotte M E Kremer
- Drs. March, Chrisman, and Kondo are with the Department of Psychiatry, Duke University Medical Center, Durham, NC; Dr. Szatmari is with the Department of Psychiatry at McMaster University, Hamilton, Ontario; Canada; Dr. Bukstein is with Western Psychiatric Institute and Clinic, University of Pittsburgh; Dr. Hamilton is with The Permanente Medical Group of California; Dr. Kremer is with Pfizer, Inc.; Dr. Kratochvil is with the Department of Psychiatry, University of Nebraska Medical Center, Omaha
| | - Christopher J Kratochvil
- Drs. March, Chrisman, and Kondo are with the Department of Psychiatry, Duke University Medical Center, Durham, NC; Dr. Szatmari is with the Department of Psychiatry at McMaster University, Hamilton, Ontario; Canada; Dr. Bukstein is with Western Psychiatric Institute and Clinic, University of Pittsburgh; Dr. Hamilton is with The Permanente Medical Group of California; Dr. Kremer is with Pfizer, Inc.; Dr. Kratochvil is with the Department of Psychiatry, University of Nebraska Medical Center, Omaha
| |
Collapse
|
60
|
Raghavan R, Inkelas M, Franke T, Halfon N. Administrative barriers to the adoption of high-quality mental health services for children in foster care: a national study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2007; 34:191-201. [PMID: 17211714 DOI: 10.1007/s10488-006-0095-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Accepted: 09/07/2006] [Indexed: 11/28/2022]
Abstract
While the need to provide appropriate mental health services to children in foster care is well recognized, there is little information on administrative barriers to assuring that such services are provided. This article presents results from a national survey of mental health agencies to profile their awareness of currently available practice standards, the roles these standards play in guiding practice of mental health agencies, common reimbursement strategies in use for mental health services, and collaborations between mental health and child welfare agencies that enhance children's access to appropriate mental health care. Implications and recommendations for mental health policymakers are discussed.
Collapse
Affiliation(s)
- Ramesh Raghavan
- George Warren Brown School of Social Work, Department of Psychiatry, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130, USA.
| | | | | | | |
Collapse
|
63
|
Bloch RM, Saeed SA, Rivard JC, Rausch C. Lessons learned in implementing evidence-based practices: implications for psychiatric administrators. Psychiatr Q 2006; 77:309-18. [PMID: 16927164 DOI: 10.1007/s11126-006-9016-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Factors related to the dissemination and implementation of evidence-based practices (EBPs) are discussed. Extensive effort is required to successfully implement and sustain EBPs that improve clinical outcomes. There is a rapid rate of discovery of new EBPs. Examples of large-scale implementations of EBPs in mental health are described with emphasis on the factors thought critical for success. The need for designing systems which can cost-effectively implement new EBPs is highlighted. Finally, the implications for psychiatric administrators are discussed.
Collapse
Affiliation(s)
- Richard M Bloch
- Department of Psychiatric Medicine, Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA.
| | | | | | | |
Collapse
|