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Reeder K, Park AL, Chorpita BF. Turning Back to Treatment: The Effect of Attendance and Symptom Outcomes on Subsequent Service Use. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:641-647. [PMID: 32170492 DOI: 10.1007/s10488-020-01032-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study explored whether post-treatment symptom severity moderated the association between session attendance during an initial treatment episode and subsequent mental health service use. Data on attendance, symptom severity, and service use were gathered from an effectiveness trial testing a modular treatment for youth anxiety, depression, disruptive behavior, and traumatic stress. Multilevel logistic regression analyses showed a significant interaction between attendance and post-treatment symptom severity on subsequent service use, such that attendance significantly predicted subsequent service use when post-treatment symptom severity was in the normal range. Implications regarding the influence of treatment engagement on future help-seeking are discussed.
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Affiliation(s)
- Kendal Reeder
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0812, USA.
- Child and Adolescent Services Research Center, San Diego, CA, 92123, USA.
| | - Alayna L Park
- University of California, Los Angeles, Los Angeles, USA
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Hamilton AB, Brown A, Loeb T, Chin D, Grills C, Cooley-Strickland M, Liu HH, Wyatt GE. Enhancing patient and organizational readiness for cardiovascular risk reduction among Black and Latinx patients living with HIV: Study protocol. Prog Cardiovasc Dis 2020; 63:101-108. [PMID: 32109483 DOI: 10.1016/j.pcad.2020.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 02/23/2020] [Indexed: 01/14/2023]
Abstract
Cardiovascular disease (CVD) is an increasingly important cause of morbidity and mortality among people living with HIV (PLWH) now that HIV is a manageable chronic disease. Identification and treatment of comorbid medical conditions for PLWH, including CVD and its risk factors, typically lack a critical component of care: integrated care for histories of trauma. Experiences of trauma are associated with increased HIV infection, CVD risk, inconsistent treatment adherence, and poor CVD outcomes. To address this deficit among those at greatest risk and disproportionately affected by HIV and trauma-i.e., Black and Latinx individuals-a novel culturally-congruent, evidence-informed care model, "Healing our Hearts, Minds and Bodies" (HHMB), has been designed to address patients' trauma histories and barriers to care, and to prepare patients to engage in CVD risk reduction. Further, in recognition of the need to ensure that PLWH receive guideline-concordant cardiovascular care, implementation strategies have been identified that prepare providers and clinics to address CVD risk among their Black and Latinx PLWH. The focus of this paper is to describe the hybrid Type 2 effectiveness/implementation study design, the goal of which is to increase both patient and organizational readiness to address trauma and CVD risk among 260 Black and Latinx PLWH recruited from two HIV service organizations in Southern California. This study is expected to produce important information regarding the value of the HHMB intervention and implementation processes and strategies designed for use in implementing HHMB and other evidence-informed programs in diverse, resource-constrained treatment settings, including those that serve patients living in deep poverty. Clinical trials registry: NCT04025463.
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Affiliation(s)
- Alison B Hamilton
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, United States of America; Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America.
| | - Arleen Brown
- Division of General Internal Medicine and Health Services Research (GIM and HSR), University of California Los Angeles, United States of America; Division of GIM and HSR, Olive View-UCLA Medical Center, Sylmar, CA United States of America
| | - Tamra Loeb
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, United States of America
| | - Dorothy Chin
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, United States of America
| | - Cheryl Grills
- Department of Psychology, Loyola Marymount University, United States of America
| | - Michele Cooley-Strickland
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, United States of America
| | - Honghu H Liu
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, United States of America
| | - Gail E Wyatt
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, United States of America
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Westman JG, Daleiden EL, Chorpita BF. The agency supervisor model: developing supervisors who facilitate therapist transfer of training in community behavioral health service organizations. CLINICAL SUPERVISOR 2019. [DOI: 10.1080/07325223.2019.1695159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jonathan G. Westman
- Department of Psychology, University of California, Los Angeles, California, USA
| | | | - Bruce F. Chorpita
- Department of Psychology, University of California, Los Angeles, California, USA
- PracticeWise, LLC., Satellite Beach, Florida, USA
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Weisz JR, Bearman SK, Ugueto AM, Herren JA, Evans SC, Cheron DM, Alleyne AR, Weissman AS, Tweed JL, Pollack AA, Langer DA, Southam-Gerow MA, Wells KC, Jensen-Doss A. Testing Robustness of Child STEPs Effects with Children and Adolescents: A Randomized Controlled Effectiveness Trial. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:883-896. [PMID: 31517543 DOI: 10.1080/15374416.2019.1655757] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A critical task in psychotherapy research is identifying the conditions within which treatment benefits can be replicated and outside of which those benefits are reduced. We tested the robustness of beneficial effects found in two previous trials of the modular Child STEPs treatment program for youth anxiety, depression, trauma, and conduct problems. We conducted a randomized trial, with two significant methodological changes from previous trials: (a) shifting from cluster- to person-level randomization, and (b) shifting from individual to more clinically feasible group-based consultation with STEPs therapists. Fifty community clinicians from multiple outpatient clinics were randomly assigned to receive training and consultation in STEPs (n= 25) or to provide usual care (UC; n= 25). There were 156 referred youths-ages 6-16 (M= 10.52, SD = 2.53); 48.1% male; 79.5% Caucasian, 12.8% multiracial, 4.5% Black, 1.9% Latino, 1.3% Other-who were randomized to STEPs (n= 77) or UC (n= 79). Following previous STEPs trials, outcome measures included parent- and youth-reported internalizing, externalizing, total, and idiographic top problems, with repeated measures collected weekly during treatment and longer term over 2 years. Participants in both groups showed statistically significant improvement on all measures, leading to clinically meaningful problem reductions. However, in contrast to previous trials, STEPs was not superior to UC on any measure. As with virtually all treatments, the benefits of STEPs may depend on the conditions-for example, of study design and implementation support-in which it is tested. Identifying those conditions may help guide appropriate use of STEPs, and other treatments, in the future.
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Affiliation(s)
| | | | - Ana M Ugueto
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Jenny A Herren
- Department of Psychiatry and Human Behavior, Brown University
| | | | | | | | - Adam S Weissman
- The Child & Family Institute and Columbia University Teacher's College
| | | | | | | | | | - Karen C Wells
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
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Young J, Ramachandran S, Freeman AJ, Bentley JP, Banahan BF. Patterns of treatment for psychiatric disorders among children and adolescents in Mississippi Medicaid. PLoS One 2019; 14:e0221251. [PMID: 31415651 PMCID: PMC6695227 DOI: 10.1371/journal.pone.0221251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 08/04/2019] [Indexed: 11/19/2022] Open
Abstract
The nature of services for psychiatric disorders in public health systems has been understudied, particularly with regard to frequency, duration, and costs. The current study examines patterns of service reception and costs among Medicaid-covered youth newly diagnosed with anxiety, depression, or behavioral disturbance in a large data set of provider billing claims submitted between 2015-2016. Eligibility criteria included: 1) identification of an initial diagnosis of a single anxiety, unipolar mood, or specific behavioral disorder; 2) continuous Medicaid eligibility over the duration of the time period studied; and 3) under 18 years of age on the date of initial psychiatric diagnosis. The final cohort included 7,627 cases with a mean age of 10.65 (±4.36), of which 58.04% were male, 57.09% were Black, 38.97% were White, and 3.95% were of other ethnicities. Data indicated that 65.94% of the cohort received at least some follow-up services within a median 18 days of diagnosis. Of those, 54.27% received a combination of medical and psychosocial services, 32.01% received medical services only, and 13.72% received psychosocial services only. Overall median costs for direct treatment were $576.69, with wide discrepancies between the lowest (anxiety = $308.41) and highest (behavioral disturbance = $653.59) diagnostic categories. Across all categories the frequency and duration of psychosocial services were much lower than would be expected in comparison to data from a well-known effectiveness trial. Overall, follow-up to psychiatric diagnosis could be characterized as highly variable, underutilized, and emphasizing biomedical treatment. Understanding more about these patterns may facilitate systematic improvements and greater cost efficiency in the future.
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Affiliation(s)
- John Young
- Department of Psychology, University of Mississippi, Oxford, MS, United States of America
| | - Sujith Ramachandran
- Department of Pharmacy Administration, University of Mississippi, Oxford, MS, United States of America
| | - Andrew J. Freeman
- Department of Psychology, University of Nevada, Las Vegas, NV, United States of America
| | - John P. Bentley
- Department of Pharmacy Administration, University of Mississippi, Oxford, MS, United States of America
| | - Benjamin F. Banahan
- Department of Pharmacy Administration, University of Mississippi, Oxford, MS, United States of America
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Bakker GM. A new conception and subsequent taxonomy of clinical psychological problems. BMC Psychol 2019; 7:46. [PMID: 31291999 PMCID: PMC6617608 DOI: 10.1186/s40359-019-0318-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/12/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A taxonomy of the objects of study, theory, assessment, and intervention is critical to the development of all clinical sciences. Clinical psychology has been conceptually and administratively dominated by the taxonomy of an adjacent discipline - psychiatry's Diagnostic and statistical manual of mental disorders (DSM). Many have called for a 'paradigm shift' away from a medical nosology of diseases toward clinical psychology's own taxonomy of clinical psychological problems (CPPs), without being able to specify what is to be listed and classified. MAIN TEXT An examination of DSM's problems for clinical psychology, especially its lack of clinical utility, and a search for the essence of CPPs in what clinical psychologists actually do, leads to the proposal that: The critical psychological-level phenomenon underlying CPPs is the occurrence of 'problem-maintaining circles' (PMCs) of causally related cognitions, emotions, behaviours, and/or stimuli. This concept provides an empirically-derived, theory-based, treatment-relevant, categorical, essentialist, parsimonious, and nonstigmatizing definition of CPPs. It distinguishes psychological problems in which PMCs have not (yet?) formed, and which may respond to 'counseling', clinical psychological problems in which active PMCs require clinical intervention, and psychopathological problems which are unlikely to be 'cured' by PMC-breaking alone. CONCLUSION A subsequent classification and coding system of PMCs is proposed, and expected benefits to research, communication, and the quality of case formulation in clinical psychology are described, reliant upon a development effort of some meaningful fraction of that which has been devoted to the DSM.
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Affiliation(s)
- Gary M Bakker
- School of Medicine, University of Tasmania, Locked Bag 1377, Launceston, Tasmania, 7250, Australia.
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Shaffer A, Fitzgerald MM, Shipman K, Torres M. Let’s Connect: A developmentally-driven emotion-focused parenting intervention. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2019. [DOI: 10.1016/j.appdev.2019.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fairchild G, Hawes DJ, Frick PJ, Copeland WE, Odgers CL, Franke B, Freitag CM, De Brito SA. Conduct disorder. Nat Rev Dis Primers 2019; 5:43. [PMID: 31249310 DOI: 10.1038/s41572-019-0095-y] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 02/06/2023]
Abstract
Conduct disorder (CD) is a common and highly impairing psychiatric disorder that usually emerges in childhood or adolescence and is characterized by severe antisocial and aggressive behaviour. It frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD) and often leads to antisocial personality disorder in adulthood. CD affects ~3% of school-aged children and is twice as prevalent in males than in females. This disorder can be subtyped according to age at onset (childhood-onset versus adolescent-onset) and the presence or absence of callous-unemotional traits (deficits in empathy and guilt). The aetiology of CD is complex, with contributions of both genetic and environmental risk factors and different forms of interplay among the two (gene-environment interaction and correlation). In addition, CD is associated with neurocognitive impairments; smaller grey matter volume in limbic regions such as the amygdala, insula and orbitofrontal cortex, and functional abnormalities in overlapping brain circuits responsible for emotion processing, emotion regulation and reinforcement-based decision-making have been reported. Lower hypothalamic-pituitary-adrenal axis and autonomic reactivity to stress has also been reported. Management of CD primarily involves parent-based or family-based psychosocial interventions, although stimulants and atypical antipsychotics are sometimes used, especially in individuals with comorbid ADHD.
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Affiliation(s)
| | - David J Hawes
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Paul J Frick
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA and Institute for Learning Science and Teacher Education, Australian Catholic University, Brisbane, Queensland, Australia
| | | | - Candice L Odgers
- Department of Psychological Science, School of Social Ecology, University of California, Irvine, CA, USA
| | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Stephane A De Brito
- School of Psychology and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
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Feasibility randomized controlled trial of a one-day CBT workshop ('DISCOVER') for 15- to 18-year-olds with anxiety and/or depression in clinic settings. Behav Cogn Psychother 2019; 48:142-159. [PMID: 31106728 DOI: 10.1017/s1352465819000286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND 'DISCOVER' one-day cognitive behavioural therapy (CBT) workshops have been developed to provide accessible, developmentally sensitive psychological support for older adolescents experiencing emotional difficulties. Previous school-based evaluations of the DISCOVER model have shown positive outcomes. AIMS The current study aimed to test the model for clinically referred adolescents, in real-world settings. METHOD A randomized controlled trial (RCT) assessed feasibility, acceptability and preliminary outcomes of the DISCOVER intervention, in comparison with usual care, for 15- to 18-year-olds with emotional difficulties. Participants were recruited from outpatient clinic waiting lists in UK child and adolescent mental health services (CAMHS). Research feasibility indicators included rates of recruitment, randomization, intervention participation (group workshops and individualized follow-up telephone calls), and data collection (at baseline and 8-week follow-up). Intervention acceptability was assessed using a structured service satisfaction questionnaire and semi-structured qualitative interviews with intervention participants. Preliminary clinical outcomes were explored using adolescent-reported validated measures of depression, anxiety and well-being. RESULTS n = 24 participants were randomized to intervention and usual care groups. Workshop attendance was good and high levels of treatment satisfaction were reported, although feasibility challenges emerged in recruitment and randomization. Trends were found towards potential improvements in anxiety and well-being for the intervention group, but the effect estimate for depression was imprecise; interpretability was also limited due to the small sample size. CONCLUSIONS DISCOVER appears to be a feasible and acceptable intervention model for clinically referred 15- to 18-year-olds with emotional difficulties. A full-scale RCT is warranted to evaluate effectiveness; protocol modifications may be necessary to ensure feasible recruitment and randomization procedures.
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Dowling K, Simpkin AJ, Barry MM. A Cluster Randomized-Controlled Trial of the MindOut Social and Emotional Learning Program for Disadvantaged Post-Primary School Students. J Youth Adolesc 2019; 48:1245-1263. [PMID: 31004264 DOI: 10.1007/s10964-019-00987-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/28/2019] [Indexed: 11/27/2022]
Abstract
School-based social and emotional learning programs aim to provide students with the skills they need to deal with life challenges, thereby enhancing their social and emotional wellbeing, academic outcomes, and reducing their risk of mental health difficulties. While there is a robust evidence base on the effectiveness of these programs originating from the US, there is a relative paucity of research on how these programs impact young people in other county contexts, especially for older adolescents and those at higher risk. This study sets out to address this research gap by evaluating the effectiveness of a social emotional learning program designed for older adolescents in Ireland, the MindOut program. MindOut is a universal school-based social and emotional learning program designed for older adolescents in Ireland which was developed based on a common elements approach underpinned by CASEL's framework. Employing a cluster randomized-controlled trial, data on social and emotional skills, academic performance and mental health outcomes were collected from students (n = 497; 51.1% female) ages 15-18 years in 32 disadvantaged schools. There were significant improvements in intervention students' social and emotional skills including, reduced suppression of emotions (p = 0.035), use of more positive coping strategies [reduced avoidance coping p = < 0.001) and increased social support coping p = 0.044)]. Improvements in mental health and wellbeing were also found with significantly reduced levels of stress (p = 0.017) and depressive symptoms (p = 0.030) as well as reduced anxiety scores for females students (p = 0.044). These short-term evaluation findings support the positive impact of school-based social and emotional learning programs, such as MindOut, when designed to be both age and culturally appropriate and delivered to older adolescents in disadvantaged schools.
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Affiliation(s)
- Katherine Dowling
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland.
| | - Andrew J Simpkin
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland
| | - Margaret M Barry
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
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Weisz JR, Vaughn-Coaxum RA, Evans SC, Thomassin K, Hersh J, Ng MY, Lau N, Lee EH, Raftery-Helmer JN, Mair P. Efficient Monitoring of Treatment Response during Youth Psychotherapy: The Behavior and Feelings Survey. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:737-751. [PMID: 30657721 DOI: 10.1080/15374416.2018.1547973] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
An emerging trend in youth psychotherapy is measurement-based care (MBC): treatment guided by frequent measurement of client response, with ongoing feedback to the treating clinician. MBC is especially needed for treatment that addresses internalizing and externalizing problems, which are common among treatment-seeking youths. A very brief measure is needed, for frequent administration, generating both youth- and caregiver-reports, meeting psychometric standards, and available at no cost. We developed such a measure to monitor youth response during psychotherapy for internalizing and externalizing problems. Across 4 studies, we used ethnically diverse, clinically relevant samples of caregivers and youths ages 7-15 to develop and test the Behavior and Feelings Survey (BFS). In Study 1, candidate items identified by outpatient youths and their caregivers were examined via an MTurk survey, with item response theory methods used to eliminate misfitting items. Studies 2-4 used separate clinical samples of youths and their caregivers to finalize the 12-item BFS (6 internalizing and 6 externalizing items), examine its psychometric properties, and assess its performance in monitoring progress during psychotherapy. The BFS showed robust factor structure, internal consistency, test-retest reliability, convergent and discriminant validity in relation to three well-established symptom measures, and slopes of change indicating efficacy in monitoring treatment progress during therapy. The BFS is a brief, free youth- and caregiver-report measure of internalizing and externalizing problems, with psychometric evidence supporting its use for MBC in clinical and research contexts.
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Affiliation(s)
| | | | | | | | | | - Mei Yi Ng
- Department of Psychology, Florida International University
| | - Nancy Lau
- Department of Pediatrics, University of Washington School of Medicine
| | - Erica H Lee
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School
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Thastum M, Johnsen DB, Silverman WK, Jeppesen P, Heyne DA, Lomholt JJ. The Back2School modular cognitive behavioral intervention for youths with problematic school absenteeism: study protocol for a randomized controlled trial. Trials 2019; 20:29. [PMID: 30621787 PMCID: PMC6325742 DOI: 10.1186/s13063-018-3124-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND School absenteeism (SA) is associated with anxiety, depression, and disruptive behavior. It is a risk factor for academic difficulties and school dropout, which predict problems in adulthood such as social, work-related, and health problems. The main goal of this study is to examine the initial effectiveness of a modular transdiagnostic cognitive behavioral therapy (CBT) intervention (Back2School) for increasing school attendance and decreasing psychological problems, relative to a comparator control arm (treatment as usual [TAU]). METHODS/DESIGN One hundred sixty children, aged 7 to 16 years, will be randomly assigned to either Back2School or TAU. The design is a two (Back2School and TAU) by four (preassessment [T1], postassessment [T2], and 3-month [T3] and 1-year [T4] assessments) mixed between-within design. The primary outcome is school attendance based on daily registration. Secondary outcomes pertain to youth psychosocial functioning, quality of life, bullying, self-efficacy, and teacher-parent collaboration. These secondary outcomes are measured via youth, parent, and teacher reports. DISCUSSION This study will provide critically needed empirical evidence on the initial effectiveness of a manualized treatment program for youth with SA. If the intervention is found to be effective, the program can be further implemented and tested in a larger school health effectiveness trial. TRIAL REGISTRATION ClinicalTrials.gov, NCT03459677 . Retrospectively registered on 9 March 2018.
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Affiliation(s)
- Mikael Thastum
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.
| | - Daniel Bach Johnsen
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | | | - Pia Jeppesen
- Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Child and Adolescent Mental Health Center, Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark
| | - David A Heyne
- Institute of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, The Netherlands
| | - Johanne Jeppesen Lomholt
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.,TrygFonden's Center for Child Research, Aarhus University, Aarhus, Denmark
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Hagen KA, Olseth AR, Laland H, Rognstad K, Apeland A, Askeland E, Taraldsen K, Christensen B, Kjøbli J, Ugueto AM, Bearman SK, Weisz J. Evaluating Modular Approach to Therapy for Children with Anxiety, Depression, Trauma and Conduct Problems (MATCH-ADCT) in Norwegian child and adolescent outpatient clinics: Study protocol for a randomized controlled trial. Trials 2019; 20:16. [PMID: 30616662 PMCID: PMC6322284 DOI: 10.1186/s13063-018-3074-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Norwegian health, care, and welfare services are experiencing increased demands to deliver services that are safe, effective, of high quality, and that ensure user involvement. Yet, evidence-based treatment for common disorders such as depression, anxiety, trauma, and behavioral problems in children are not regularly used in clinical practice in Norway. Possible explanations for this are that many standard, evidence-based treatments may have difficulty addressing the complexity and comorbidity of referred children and the fact that children's treatment needs often shift during treatment. The Modular Approach to Therapy for children with Anxiety, Depression, Trauma and Conduct problems (MATCH-ADTC) was designed to address these challenges and reduce some of the barriers to therapists' use of evidence-based treatment in their practice. METHODS/DESIGN Participants will include 280 children (aged 6-14.5 years at intake) who receive treatment in child and adolescent mental health outpatient clinics in Norway, and their families. Families are randomly assigned to either the experimental group receiving treatment from therapists trained in MATCH, or to the comparison group receiving treatment from therapists delivering treatment as usual (TAU). Data on children's symptomology, child and family functioning, demographics, background information, and mental health outcomes are collected as well as frequent feedback on treatment response, plus video-recordings of treatment sessions and implementation quality scores from each participating clinic. Questionnaires are administered in six waves. DISCUSSION MATCH has been tested in the US with promising results, but we do not know whether this treatment approach will produce similar results in Norway. The implications of this study are 1. Possibly better treatment outcomes and/or more efficient improvements for children and families treated in mental health outpatient clinics in Norway 2. Clinicians learning to use more evidence-based practices in their treatment 3. Implementation of standard procedures for obtaining feedback from children and families and sharing the feedback with clinicians 4. Increased understanding, at the end of the trial, of whether introducing MATCH improves outcomes for children and families treated in mental health outpatient clinics TRIAL REGISTRATION: ISRCTN, registration number: ISRCTN24029895 . Registered on 8 August 2016.
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Affiliation(s)
- Kristine Amlund Hagen
- The Norwegian Center for Child Behavioral Development (NCCBD), a University of Oslo affiliate, Postboks 7053, Majorstuen, 0306, Oslo, Norway.
| | - Asgeir Røyrhus Olseth
- The Norwegian Center for Child Behavioral Development (NCCBD), a University of Oslo affiliate, Postboks 7053, Majorstuen, 0306, Oslo, Norway
| | - Hanne Laland
- The Norwegian Center for Child Behavioral Development (NCCBD), a University of Oslo affiliate, Postboks 7053, Majorstuen, 0306, Oslo, Norway
| | - Kristian Rognstad
- Regional Center for Child and Adolescent mental health, Eastern and Southern Norway, Nydalen, Postboks 4623, 0405, Oslo, Norway
| | - Anett Apeland
- The Norwegian Center for Child Behavioral Development (NCCBD), a University of Oslo affiliate, Postboks 7053, Majorstuen, 0306, Oslo, Norway
| | - Elisabeth Askeland
- The Norwegian Center for Child Behavioral Development (NCCBD), a University of Oslo affiliate, Postboks 7053, Majorstuen, 0306, Oslo, Norway
| | - Knut Taraldsen
- The Norwegian Center for Child Behavioral Development (NCCBD), a University of Oslo affiliate, Postboks 7053, Majorstuen, 0306, Oslo, Norway
| | - Bernadette Christensen
- The Norwegian Center for Child Behavioral Development (NCCBD), a University of Oslo affiliate, Postboks 7053, Majorstuen, 0306, Oslo, Norway
| | - John Kjøbli
- Regional Center for Child and Adolescent mental health, Eastern and Southern Norway, Nydalen, Postboks 4623, 0405, Oslo, Norway
| | - Ana M Ugueto
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, McGovern Medical School, 7000 Fannin St #1200, Houston, TX, 77030, USA
| | - Sarah Kate Bearman
- Department of Educational Psychology at the University of Texas at Austin, 1912 Speedway Stop D5800, Austin, TX, 78712, USA
| | - John Weisz
- Department of Psychology, Faculty of Arts and Sciences, Harvard University, 1030 William James Hall, 33 Kirkland Street, Cambridge, MA, 02138, USA
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Kratz HE, Stahmer A, Xie M, Marcus SC, Pellecchia M, Locke J, Beidas R, Mandell DS. The effect of implementation climate on program fidelity and student outcomes in autism support classrooms. J Consult Clin Psychol 2018; 87:270-281. [PMID: 30570312 DOI: 10.1037/ccp0000368] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE An organization's implementation climate, or the extent to which use of an intervention is expected, supported, and rewarded by colleagues and supervisors, has been identified as critical to successful intervention implementation and outcomes. The effect of implementation climate has not been well studied in special education settings. The present study examines the association between teachers' perceptions of implementation climate, teacher fidelity to a school-based program for students with autism, and student outcomes (measured as changes in IQ) over time. METHOD Participants included 158 students from 45 classrooms and their teachers. Teachers provided a measure of implementation climate at the beginning of the academic year; program fidelity was measured monthly throughout the year. The main and interaction effects of perceived implementation climate and fidelity on student outcomes were examined using longitudinal nested linear models with random effects for classroom and student, controlling for important covariates. RESULTS On average, IQ scores improved 2.2 points (SD = 8.7). There were no main effects of perceived implementation climate or fidelity on student outcomes; however, the interaction between perceived implementation climate and fidelity was associated with student outcomes (p < .05, d = 0.54). Among classrooms with a strong perceived implementation climate, higher fidelity was associated with better student outcomes. CONCLUSIONS While preliminary and requiring replication, these findings suggest that perceived implementation climate and program fidelity each may be important but not sufficient for optimizing outcomes for students with autism. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Jill Locke
- Department of Speech and Hearing Sciences
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Martin P, Murray LK, Darnell D, Dorsey S. Transdiagnostic treatment approaches for greater public health impact: Implementing principles of evidence‐based mental health interventions. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Prerna Martin
- Department of PsychologyUniversity of Washington Seattle Washington
| | - Laura K Murray
- Department of Mental HealthJohns Hopkins Bloomberg School of Public Health Baltimore Maryland
| | - Doyanne Darnell
- Department of Psychiatry and Behavioral SciencesUniversity of Washington Seattle Washington
| | - Shannon Dorsey
- Department of PsychologyUniversity of Washington Seattle Washington
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Platt RE, Spencer AE, Burkey MD, Vidal C, Polk S, Bettencourt AF, Jain S, Stratton J, Wissow LS. What's known about implementing co-located paediatric integrated care: a scoping review. Int Rev Psychiatry 2018; 30:242-271. [PMID: 30912463 PMCID: PMC6499629 DOI: 10.1080/09540261.2018.1563530] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Several studies have demonstrated clinical benefits of integrated care for a range of child and adolescent mental health outcomes. However, there is a significant gap between the evidence for efficacy of integrated care interventions vs their implementation in practice. While several studies have examined large-scale implementation of co-located integrated care for adults, much less is known for children. The goal of this scoping review was to understand how co-located mental health interventions targeting children and adolescents have been implemented and sustained. The literature was systematically searched for interventions targeting child and adolescent mental health that involved a mental health specialist co-located in a primary care setting. Studies reporting on the following implementation outcomes were included: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability. This search identified 34 unique studies, including randomized controlled trials, observational studies, and survey/mixed method approaches. Components facilitating implementation of on-site integrated behavioural healthcare included interprofessional communication and collaboration at all stages of implementation; clear protocols to facilitate intervention delivery; and co-employment of integrated care providers by specialty clinics. Some studies found differences in service use by demographic factors, and others reported funding challenges affecting sustainability, warranting further study.
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Affiliation(s)
| | | | | | - Carolina Vidal
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Sarah Polk
- Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Amie F Bettencourt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Sonal Jain
- New York Institute of Technology College of Osteopathic Medicine
| | - Julia Stratton
- Vancouver Coastal Health Authority, Pacific Spirit and Raven Song Child and Youth Mental Health Teams
| | - Lawrence S Wissow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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68
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Kreuze LJ, Pijnenborg GHM, de Jonge YB, Nauta MH. Cognitive-behavior therapy for children and adolescents with anxiety disorders: A meta-analysis of secondary outcomes. J Anxiety Disord 2018; 60:43-57. [PMID: 30447493 DOI: 10.1016/j.janxdis.2018.10.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 10/01/2018] [Accepted: 10/22/2018] [Indexed: 01/18/2023]
Abstract
Anxiety-focused cognitive-behavioral therapy (CBT) effectively reduces anxiety in children and adolescents. An important remaining question is to what extent anxiety-focused CBT also affects broader outcome domains. Additionally, it remains unclear whether parental involvement in treatment may have impact on domains other than anxiety. A meta-analysis (nstudies = 42, nparticipants = 3239) of the effects of CBT and the moderating role of parental involvement was conducted on the following major secondary outcomes: depressive symptoms, externalizing behaviors, general functioning, and social competence. Randomized controlled trials were included when having a waitlist or active control condition, a youth sample (aged<19) with a primary anxiety disorder diagnosis receiving anxiety-focused CBT and reported secondary outcomes. Controlled effect sizes (Cohen's d) were calculated employing random effect models. CBT had a large effect on general functioning (-1.25[-1.59;0.90], nstudies = 17), a small to moderate effect on depressive symptoms (-0.31[-0.41;-0.22], nstudies = 31) and a small effect on externalizing behaviors (-0.23[-0.38;-0.09], nstudies = 12) from pre-to post-treatment. Effects remained or even further improved at follow-up. Social competence only improved at follow-up (nstudies = 6). Concluding, anxiety-focused CBT has a positive effect on broader outcome domains than just anxiety. Higher parental involvement seemed to have beneficial effects at follow-up, with improvements in general functioning and comorbid symptoms.
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Affiliation(s)
- L J Kreuze
- Department of Psychology, University of Groningen, Groningen, the Netherlands.
| | - G H M Pijnenborg
- Department of Psychology, University of Groningen, Groningen, the Netherlands; GGZ Drenthe, Department of Psychotic Disorders, Assen, The Netherlands.
| | - Y B de Jonge
- Department of Psychology, University of Groningen, Groningen, the Netherlands.
| | - M H Nauta
- Department of Psychology, University of Groningen, Groningen, the Netherlands.
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Lyon AR, Stanick C, Pullmann MD. Toward high‐fidelity treatment as usual: Evidence‐based intervention structures to improve usual care psychotherapy. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Philippot P, Bouvard M, Baeyens C, Dethier V. Case conceptualization from a process-based and modular perspective: Rationale and application to mood and anxiety disorders. Clin Psychol Psychother 2018; 26:175-190. [PMID: 30338874 DOI: 10.1002/cpp.2340] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/28/2018] [Accepted: 10/01/2018] [Indexed: 11/11/2022]
Abstract
This article presents the theoretical, clinical, and practical arguments supporting a process-based transdiagnostic approach to psychotherapy. A working definition of "psychological process" is provided, as well as a tri-dimensional categorization of psychological processes potentially involved in psychopathology. Guidelines are proposed to select psychological interventions based on the active psychopathological processes evidenced in a given case. We also provide a rationale to organize treatment as a set of modules, each addressing a specific psychopathological process. Next, we review the main processes that may be active in mood and anxiety disorders, and that are accessible to clinicians in regular practice. For each process, we propose a validated assessment questionnaire. Finally, we offer a free-access web-based instrument that allows clients to fill in these questionnaires via an internet survey, and that provides therapists with a tool to easily decode and interpret the questionnaire results and to present them to the clients.
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Affiliation(s)
- Pierre Philippot
- Laboratoire de Psychopathologie Expérimentale, Université catholique of Louvain, Louvain-la-Neuve, Belgium
| | - Martine Bouvard
- Département de Psychologie, Université de Savoie Mont Blanc, Chambéry, France
| | - Céline Baeyens
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, Grenoble, France
| | - Vincent Dethier
- Laboratoire de Psychopathologie Expérimentale, Université catholique of Louvain, Louvain-la-Neuve, Belgium
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Kilbourne AM, Smith SN, Choi SY, Koschmann E, Liebrecht C, Rusch A, Abelson JL, Eisenberg D, Himle JA, Fitzgerald K, Almirall D. Adaptive School-based Implementation of CBT (ASIC): clustered-SMART for building an optimized adaptive implementation intervention to improve uptake of mental health interventions in schools. Implement Sci 2018; 13:119. [PMID: 30185192 PMCID: PMC6126013 DOI: 10.1186/s13012-018-0808-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022] Open
Abstract
Background Depressive and anxiety disorders affect 20–30% of school-age youth, most of whom do not receive adequate services, contributing to poor developmental and academic outcomes. Evidence-based practices (EBPs) such as cognitive behavioral therapy (CBT) can improve outcomes, but numerous barriers limit access among affected youth. Many youth try to access mental health services in schools, but school professionals (SPs: counselors, psychologists, social workers) are rarely trained adequately in CBT methods. Further, SPs face organizational barriers to providing CBT, such as lack of administrative support. Three promising implementation strategies to address barriers to school-based CBT delivery include (1) Replicating Effective Programs (REP), which deploys customized CBT packaging, didactic training in CBT, and technical assistance; (2) coaching, which extends training via live supervision to improve SP competence in CBT delivery; and (3) facilitation, which employs an organizational expert who mentors SPs in strategic thinking to promote self-efficacy in garnering administrative support. REP is a relatively low-intensity/low-cost strategy, whereas coaching and facilitation require additional resources. However, not all schools will require all three strategies. The primary aim of this study is to compare the effectiveness of a school-level adaptive implementation intervention involving REP, coaching, and facilitation versus REP alone on the frequency of CBT delivered to students by SPs and student mental health outcomes. Secondary and exploratory aims examine cost-effectiveness, moderators, and mechanisms of implementation strategies. Methods Using a clustered, sequential multiple-assignment, randomized trial (SMART) design, ≥ 200 SPs from 100 schools across Michigan will be randomized initially to receive REP vs. REP+coaching. After 8 weeks, schools that do not meet a pre-specified implementation benchmark are re-randomized to continue with the initial strategy or to augment with facilitation. Discussion EBPs need to be implemented successfully and efficiently in settings where individuals are most likely to seek care in order to gain large-scale impact on public health. Adaptive implementation interventions hold the promise of providing cost-effective implementation support. This is the first study to test an adaptive implementation of CBT for school-age youth, at a statewide level, delivered by school staff, taking an EBP to large populations with limited mental health care access. Trial registration NCT03541317—Registered on 29 May 2018 on ClinicalTrials.gov PRS Electronic supplementary material The online version of this article (10.1186/s13012-018-0808-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy M Kilbourne
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA. .,U.S. Department of Veterans Affairs, Quality Enhancement Research Initiative, Washington D.C., USA.
| | - Shawna N Smith
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Seo Youn Choi
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Elizabeth Koschmann
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Celeste Liebrecht
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Amy Rusch
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James L Abelson
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel Eisenberg
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joseph A Himle
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Kate Fitzgerald
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel Almirall
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Park AL, Moskowitz AL, Chorpita BF. Community-Based Providers' Selection of Practices for Children and Adolescents With Comorbid Mental Health Problems. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2018; 47:796-807. [PMID: 27610741 PMCID: PMC5344770 DOI: 10.1080/15374416.2016.1188706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The goal of this study is to explore providers' patterns of implementation by investigating how community mental health providers selected therapy practice modules from a flexible, modular evidence-based treatment working with youths with comorbid mental health problems. Data were obtained from 57 youths, 5-15 years old, presenting with anxiety, depressive, and/or conduct problems and their 27 providers during their participation in an effectiveness trial involving a modular evidence-based treatment. Although all youths evidenced clinically elevated symptomatology in at least two problem areas, providers targeted youths' comorbid problems with only about half of their study cases. Practice modules indicated for youths' comorbid problems were typically used less frequently and with less depth relative to practice modules indicated for youths' principal clinical problem and were often transdiagnostic in nature (i.e., designed to target more than one problem area). To determine whether providers' decisions to target youths' comorbid problems were systematic, multilevel, logistic regression analyses were conducted and revealed that youths' pretreatment characteristics and time in therapy influenced providers' patterns of module selection. Providers tend to use, but not exploit, the flexibility allowed by modular EBTs and to focus treatment on youths' principal presenting problem. In addition, providers appear to make these practice choices in a systematic and rational manner, and whether and which choices are associated with improved outcomes is an important area of future study.
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Affiliation(s)
- Alayna L Park
- a Department of Psychology , University of California , Los Angeles
| | | | - Bruce F Chorpita
- a Department of Psychology , University of California , Los Angeles
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Murray LK, Haroz EE, Doty SB, Singh NS, Bogdanov S, Bass J, Dorsey S, Bolton P. Testing the effectiveness and implementation of a brief version of the Common Elements Treatment Approach (CETA) in Ukraine: a study protocol for a randomized controlled trial. Trials 2018; 19:418. [PMID: 30075806 PMCID: PMC6090833 DOI: 10.1186/s13063-018-2752-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/19/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Mental illness is a major public health concern. Despite progress understanding which treatments work, a significant treatment gap remains. An ongoing concern is treatment length. Modular, flexible, transdiagnostic approaches have been offered as one solution to scalability challenges. The Common Elements Treatment Approach (CETA) is one such approach and offers the ability to treat a wide range of common mental health problems. CETA is supported by two randomized trials from low- and middle-income countries showing strong effectiveness and implementation outcomes. METHODS/DESIGN This trial evaluates the effectiveness and implementation of two versions of CETA using a non-inferiority design to test two primary hypotheses: (1) a brief five-session version of CETA (Brief CETA) will provide similar effectiveness for reducing the severity of common mental health problems such as depression, post-traumatic stress, impaired functioning, anxiety, and substance use problems compared with the standard 8-12-session version of CETA (Standard CETA); and (2) both Brief and Standard CETA will have superior impact on the outcomes compared to a wait-list control condition. For both hypotheses, the main effect will be assessed using longitudinal data and mixed-effects regression models over a 6-month period post baseline. A secondary aim includes exploration of implementation factors. Additional planned analyses will include exploration of: moderators of treatment impact by disorder severity and comorbidity; the impact of individual therapeutic components; and trends in symptom change between end of treatment and 6-month assessment for all participants. DISCUSSION This trial is the first rigorous study comparing a standard-length (8-12 sessions) modular, flexible, transdiagnostic, cognitive-behavioral approach to a shortened version of the approach (five sessions). Brief CETA entails "front-loading" with elements that research suggests are strong mechanisms of change. The study design will allow us to draw conclusions about the effects of both Brief and Standard CETA as well as which elements are integral to their mechanisms of action, informing future implementation and fidelity efforts. The results from this trial will inform future dissemination, implementation and scale-up of CETA in Ukraine and contribute to our understanding of the effects of modular, flexible, transdiagnostic approaches in similar contexts. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03058302 (U.S. National Library of Medicine). Registered on 20 February 2017.
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Affiliation(s)
- Laura K. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Emily E. Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - S. Benjamin Doty
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Namrita S. Singh
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Sergey Bogdanov
- Centre for Mental Health and Psychosocial Support, National University Kyiv-Mohyla Academy, Glasunova str 2/4, Kyiv, 01042 Ukraine
| | - Judith Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Guthrie Hall (GTH), 119A 98195-1525, Seattle, WA 98105 USA
| | - Paul Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Wolfe Street, Baltimore, MD 21205 USA
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Barnett ML, Brookman-Frazee L, Gonzalez JC, Zhan C, Rodriguez A, Stadnick NA, Lau AS. Qualitative Reports of How and When Therapists Adapt Children's Evidence-Based Practices during Community Implementation. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 48:894-905. [PMID: 30024316 DOI: 10.1080/15374416.2018.1485107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study analyzed qualitative therapist reports of adaptations to the delivery of multiple evidence-based practices (EBPs) within the context of a system-driven reform of children's community mental health services to understand how therapists adapt EBPs as well as contexts of these adaptations to identify when these adaptations are made. The study sought to complement and expand upon previous quantitative survey findings of two categories of Augmenting and Reducing/Reordering adaptations to EBPs. Data included interviews from 60 therapists (88.3% female, 61.7% Latina/o, 80.0% unlicensed) across 20 program sites in 11 mental health agencies that served racial/ethnically diverse children. Interviews were coded to identify themes surrounding the types of adaptations made and the contexts for these adaptations. The majority of therapists' qualitative descriptions of adaptations converged with the 2 broad categories in the Augmenting and Reducing/Reordering Framework, with therapists describing augmenting (e.g., modifying presentation, lengthening or extending pacing) most often, and reducing/reordering adaptations were discussed less frequently. Child and family characteristics were most frequently cited as indications prompting adaptations; however, the specific characteristics motivating adaptations differed by type. Therapists reporting using augmenting adaptations in the context of a wide range of client characteristics, whereas reducing/reordering adaptations occurred more specifically as a function of clinical presentation, family and caregiver functioning, and emergent life events. Therapists described making adaptations to improve the fit of multiple EBPs for the clients they served. Findings could have implications for implementation efforts with diverse clients served in community settings.
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Affiliation(s)
- Miya L Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego and Child and Adolescent Service Research Center
| | - Juan Carlos Gonzalez
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara
| | - Chanel Zhan
- Department of Psychology, University of California, Los Angeles
| | | | - Nicole A Stadnick
- Department of Psychiatry, University of California, San Diego and Child and Adolescent Service Research Center
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles
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Kennedy E. Stratified medicine and child psychology and psychiatry: An old or new paradigm? Clin Child Psychol Psychiatry 2018; 23:361-364. [PMID: 29992842 DOI: 10.1177/1359104518783378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bennett SD, Coughtrey AE, Heyman I, Greally S, Clarkson H, Bhattacharyya T, Lewis C, Varadkar S, Shafran R. Guided self-help for mental health disorders in children and young people with chronic neurological conditions: A qualitative evaluation. Eur J Paediatr Neurol 2018; 22:620-631. [PMID: 29631920 DOI: 10.1016/j.ejpn.2018.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/02/2018] [Accepted: 02/27/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Children with neurological conditions such as epilepsy are at high risk of developing mental health disorders. Guided self-help can be used to increase access to psychological therapies. When developing and evaluating interventions, it is important to obtain the views of service-users about their acceptability. A telephone-guided self-help intervention was used to treat common mental health difficulties in children and young people with neurological conditions. The intervention was not adapted in content to account for chronic illness. This study therefore reports on qualitative interviews with participants to determine the acceptability of the intervention. METHODS Semi-structured interviews were conducted with 27 participants (25 parents and 2 young people) who had undertaken a telephone-delivered guided self-help intervention for common mental health difficulties in the context of a paediatric neurological condition. Transcripts were analysed thematically using the framework approach. RESULTS Thirteen themes were extracted, organised into three main domains, which covered: the practicalities of telephone guided self-help treatment; the outcomes of the intervention; and the extent to which adaptation was needed for chronic illness. Most families found the intervention helpful in working towards their specific goals and noticed changes for the child and/or parents and family. CONCLUSIONS Participants had a positive experience of the intervention and the majority of parents found the standard intervention with individualised goals sufficient to meet the young person's mental health needs.
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Affiliation(s)
- Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom.
| | - Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Suzanna Greally
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
| | - Harriet Clarkson
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
| | - Tuhina Bhattacharyya
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
| | - Corah Lewis
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
| | - Sophia Varadkar
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom
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Hogue A, Henderson CE, Becker SJ, Knight DK. Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use, 2014-2017: Outcomes, Treatment Delivery, and Promising Horizons. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2018; 47:499-526. [PMID: 29893607 PMCID: PMC7192024 DOI: 10.1080/15374416.2018.1466307] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This article updates the evidence base on outpatient behavioral treatments for adolescent substance use (ASU) since publication of the previous review completed for this journal by Hogue, Henderson, Ozechowski, and Robbins (2014). It first summarizes the Hogue et al. findings along with those from recent literature reviews and meta-analytic studies of ASU treatments. It then presents study design and methods criteria used to select 11 comparative studies subjected to Journal of Clinical Child and Adolescent Psychology level of support evaluation. These 11 studies are detailed in terms of their sample characteristics, methodological quality, and substance use outcomes. Cumulative level of support designations are then made for each identified treatment approach. These cumulative designations are virtually identical to those of the previous review: ecological family-based treatment, individual cognitive-behavioral therapy, and group cognitive-behavioral therapy remain well-established; behavioral family-based treatment and motivational interviewing remain probably efficacious; drug counseling remains possibly efficacious; and an updated total of 5 multicomponent treatments combining more than 1 approach (3 of which include contingency management) are deemed well-established or probably efficacious. Treatment delivery issues associated with evidence-based approaches are then reviewed, focusing on client engagement, fidelity and mediator, and predictor and moderator effects. Finally, to help accelerate innovation in ASU treatment science and practice, the article outlines promising horizons in improving youth identification and access, specifying and implementing pragmatic treatment in community settings, and leveraging emerging lessons from implementation science.
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Affiliation(s)
| | | | - Sara J Becker
- c Center for Alcohol and Addictions Studies , Brown University School of Public Health
| | - Danica K Knight
- d Institute of Behavioral Research , Texas Christian University
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Chronis-Tuscano A, Danko CM, Rubin KH, Coplan RJ, Novick DR. Future Directions for Research on Early Intervention for Young Children at Risk for Social Anxiety. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2018; 47:655-667. [PMID: 29405747 PMCID: PMC6163041 DOI: 10.1080/15374416.2018.1426006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Anxiety disorders are common among young children, with earlier onset typically associated with greater severity and persistence. A stable behaviorally inhibited (BI) temperament and subsequent shyness and social withdrawal (SW) place children at increased risk of developing anxiety disorders, particularly social anxiety. In this Future Directions article, we briefly review developmental and clinical research and theory that point to parenting and peer interactions as key moderators of both the stability of BI/SW and risk for later anxiety, and we describe existing interventions that address early BI/SW and/or anxiety disorders in young children. We recommend that future research on early intervention to disrupt the trajectory of anxiety in children at risk (a) be informed by both developmental science and clinical research, (b) incorporate multiple levels of analysis (including both individual and contextual factors), (c) examine mediators that move us closer to understanding how and why treatments work, (d) be developed with the end goal of dissemination, (e) examine moderators of outcome toward the goal of treatment efficiency, (f) consider transdiagnostic or modular approaches, (g) integrate technology, and (h) consider cultural norms regarding BI/SW/anxiety and parenting.
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Affiliation(s)
| | | | - Kenneth H Rubin
- b Department of Human Development and Quantitative Methodology , University of Maryland, College Park
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79
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Sterrett-Hong EM, Karam E, Kiaer L. Statewide Implementation of Parenting with Love and Limits Among Youth with Co-Existing Internalizing and Externalizing Functional Impairments Reduces Return to Service Rates and Treatment Costs. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:792-809. [PMID: 28120298 DOI: 10.1007/s10488-016-0788-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many community mental health (CMH) systems contain inefficiencies, contributing to unmet need for services among youth. Using a quasi-experimental research design, we examined the implementation of an adapted structural-strategic family intervention, Parenting with Love and Limits, in a state CMH system to increase efficiency of services to youth with co-existing internalizing and externalizing functional impairments (PLL n = 296; Treatment-As-Usual n = 296; 54% male; 81% Caucasian). Youth receiving PLL experienced shorter treatment durations and returned to CMH services at significantly lower rates than youth receiving treatment-as-usual. They also demonstrated significant decreases in internalizing and externalizing symptoms over time. Findings lay the foundation for further examination of the role of an adapted structural-strategic family treatment in increasing the efficiency of CMH systems.
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Affiliation(s)
- Emma M Sterrett-Hong
- Couple and Family Therapy Program, Kent School of Social Work, University of Louisville, 310 N. Whittington Pkwy Burhans Hall 134, Louisville, KY, 40222, USA.
| | - Eli Karam
- Couple and Family Therapy Program, Kent School of Social Work, University of Louisville, 310 N. Whittington Pkwy Burhans Hall 134, Louisville, KY, 40222, USA
| | - Lynn Kiaer
- Hornby Zeller Associates, Inc., Troy, USA
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80
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The Feasibility and Effectiveness of School-Based Modular Therapy: A Systematic Literature Review. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9270-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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81
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Morgan NR, Davis KD, Richardson C, Perkins DF. Common components analysis: An adapted approach for evaluating programs. EVALUATION AND PROGRAM PLANNING 2018; 67:1-9. [PMID: 29132065 DOI: 10.1016/j.evalprogplan.2017.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
Common Components Analysis (CCA) summarizes the results of program evaluations that utilize randomized control trials and have demonstrated effectiveness in improving their intended outcome(s) into their key elements. This area of research has integrated and modified the existing CCA approach to provide a means of evaluating components of programs without a solid evidence-base, across a variety of target outcomes. This adapted CCA approach (a) captures a variety of similar program characteristics to increase the quality of the comparison within components; (b) identifies components from four primary areas (i.e., content, process, barrier reduction, and sustainability) within specific programming domains (e.g., vocation, social); and (c) proposes future directions to test the extent to which the common components are associated with changes in intended program outcomes (e.g., employment, job retention). The purpose of this paper is to discuss the feasibility of this adapted CCA approach. To illustrate the utility of this technique, researchers used CCA with two popular employment programs that target successful Veteran reintegration but have limited program evaluation - Hire Heroes USA and Hire Our Heroes. This adapted CCA could be applied to longitudinal research designs to identify all utilized programs and the most promising components of these programs as they relate to changes in outcomes.
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Affiliation(s)
- Nicole R Morgan
- Clearinghouse for Military Family Readiness, The Pennsylvania State University, 402 Marion Place, University Park, PA 16802, USA.
| | - Kelly D Davis
- School of Social and Behavioral Health Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR 97330, USA.
| | - Cameron Richardson
- Clearinghouse for Military Family Readiness, The Pennsylvania State University, 402 Marion Place, University Park, PA 16802, USA.
| | - Daniel F Perkins
- Clearinghouse for Military Family Readiness, The Pennsylvania State University, 402 Marion Place, University Park, PA 16802, USA; Department of Agricultural Economics, Sociology and Education, The Pennsylvania State University, 107 Ferguson Bldg, University Park, PA 16802, USA.
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82
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Measuring Costs to Community-Based Agencies for Implementation of an Evidence-Based Practice. J Behav Health Serv Res 2018; 44:122-134. [PMID: 27804099 DOI: 10.1007/s11414-016-9541-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Healthcare reform has led to an increase in dissemination of evidence-based practices. Cost is frequently cited as a significant yet rarely studied barrier to dissemination of evidence-based practices and the associated improvements in quality of care. This study describes an approach to measuring the incremental, unreimbursed costs in staff time and direct costs to community-based clinics implementing an evidence-based practice through participating in a learning collaborative. Initial implementation costs exceeding those for providing "treatment as usual" were collected for ten clinics implementing trauma-focused cognitive behavioral therapy through participation in 10-month learning collaboratives. Incremental implementation costs of these ten community-based clinic teams averaged the equivalent of US$89,575 (US$ 2012). The most costly activities were training, supervision, preparation time, and implementation team meetings. Recommendations are made for further research on implementation costs, dissemination of evidence-based practices, and implications for researchers and policy makers.
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83
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Chafouleas SM, Koriakin TA, Roundfield KD, Overstreet S. Addressing Childhood Trauma in School Settings: A Framework for Evidence-Based Practice. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9256-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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84
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Kodal A, Fjermestad K, Bjelland I, Gjestad R, Öst LG, Bjaastad JF, Haugland BSM, Havik OE, Heiervang E, Wergeland GJ. Long-term effectiveness of cognitive behavioral therapy for youth with anxiety disorders. J Anxiety Disord 2018; 53:58-67. [PMID: 29195188 DOI: 10.1016/j.janxdis.2017.11.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 11/17/2022]
Abstract
Cognitive behavioral therapy (CBT) has demonstrated favorable long-term outcomes in youth with anxiety disorders in efficacy trials. However, long-term outcomes of CBT delivered in a community setting are uncertain. This study examined the long-term outcomes of individual (ICBT) and group CBT (GCBT) in youth with anxiety disorders treated in community mental health clinics. A total of 139 youth (mean age at assessment 15.5 years, range 11-21 years) with a principal diagnosis of separation anxiety disorder (SAD), social anxiety disorder (SOP), and/or generalized anxiety disorder (GAD) were evaluated, on average, 3.9 years post-treatment (range 2.2-5.9 years). Outcomes included loss of all inclusion anxiety diagnoses, loss of the principal anxiety diagnosis and changes in youth- and parent-rated youth anxiety symptoms. At long-term follow-up, there was loss of all inclusion anxiety diagnoses in 53%, loss of the principal anxiety diagnosis in 63% of participants as well as significant reductions in all anxiety symptom measures. No statistical significant differences in outcome were obtained between ICBT and GCBT. Participants with a principal diagnosis of SOP had lower odds for recovery, compared to those with a principal diagnosis of SAD or GAD. In conclusion, outcomes of CBT for youth anxiety disorders delivered in community mental health clinics were improved at nearly 4 years post-treatment, and recovery rates at long-term follow-up were similar to efficacy trials.
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Affiliation(s)
- Arne Kodal
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021 Bergen, Norway; Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, N-5020 Bergen, Norway.
| | - Krister Fjermestad
- Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Psychology, University of Oslo, N-0373 Oslo, Norway
| | - Ingvar Bjelland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021 Bergen, Norway; Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, N-5020 Bergen, Norway
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway
| | - Lars-Göran Öst
- Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Psychology, Stockholm University, SE-106 91 Stockholm, Sweden
| | - Jon F Bjaastad
- Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Regional Center for Child and Youth Mental Health and Child Welfare, Uni Research Health, N-5008 Bergen, Norway; Division of Psychiatry, Stavanger University Hospital, N-4068 Stavanger, Norway
| | - Bente S M Haugland
- Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Regional Center for Child and Youth Mental Health and Child Welfare, Uni Research Health, N-5008 Bergen, Norway
| | - Odd E Havik
- Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, N-5020 Bergen, Norway
| | - Einar Heiervang
- Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Institute of Clinical Medicine, University of Oslo, and Oslo University Hospital, N-0450 Oslo, Norway
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021 Bergen, Norway; Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Regional Center for Child and Youth Mental Health and Child Welfare, Uni Research Health, N-5008 Bergen, Norway
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Rotheram-Fuller EJ, Swendeman D, Becker KD, Daleiden E, Chorpita B, Harris DM, Mercer NT, Rotheram-Borus MJ. Replicating Evidence-Based Practices with Flexibility for Perinatal Home Visiting by Paraprofessionals. Matern Child Health J 2017; 21:2209-2218. [PMID: 28755042 PMCID: PMC5671538 DOI: 10.1007/s10995-017-2342-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Introduction Strategies are needed to improve the efficacy of paraprofessional home visitors for pregnant women in the United States. This study evaluates the maternal and child outcomes when evidence-based practices (EBP) are replicated with flexibility, rather than fidelity to a manualized intervention. Methods Pregnant mothers (N = 203) in five clinics were recruited in the waiting rooms and randomized to standard clinic care as the control condition (n = 104) or standard care plus home visiting (n = 99). Home visitors (n = 9) were selected, trained in foundational skills common to EBP and four problem domains (weight control, breastfeeding, daily habits, and depression). Independent interviewers assessed targeted outcomes at birth (82%) and 6 months later (83%). RESULTS Home visitors, called Mentor Mothers [MM], made an average of 14.9 home visits or telephone contacts (SD = 9; total contacts = 1491) addressing maternal daily habits, breastfeeding, and depression. Intervention and control mothers were similar in weight, Body Mass Index (BMI), depression and social support at baseline and 6 months later. The percentage of low birth weight babies was similar; intervention infants' growth (weight/height Z score) tended to be significantly better compared to the control condition. DISCUSSION There are many explanations for the failure to find significant benefits: insufficient statistical power; the benefits of repeated assessments by warm, supportive peers to improve outcomes; or the failure of EBP and the need to maintain replication with fidelity. All study mothers had better outcomes than documented among comparable published samples of low-income, Latina and Korean-American mothers in Los Angeles, CA. ClinicalTrials.gov registration NCT01687634.
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Affiliation(s)
- Erin J Rotheram-Fuller
- Division of Education, Leadership and Innovation, Arizona State University, Mail Code 1811, PO Box 871811, Tempe, AZ, 85287, USA.
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
| | - Kimberly D Becker
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208, USA
| | - Eric Daleiden
- Practicewise, LLC, 340 Lee Ave, Satellite Beach, FL, 32937, USA
| | - Bruce Chorpita
- Department of Psychology, University of California at Los Angeles, 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Danielle M Harris
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
| | - Neil T Mercer
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
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Marchette LK, Weisz JR. Practitioner Review: Empirical evolution of youth psychotherapy toward transdiagnostic approaches. J Child Psychol Psychiatry 2017; 58:970-984. [PMID: 28548291 DOI: 10.1111/jcpp.12747] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psychotherapy for children and adolescents (herein, 'youths') has grown more precise and focused over the decades, shifting toward empirically supported treatments standardized via therapist manuals. The manuals have increasingly emphasized precise targeting of single disorders or problems, or homogenous clusters. These focal treatments represent a valuable advance, with intervention benefit documented in hundreds of studies. However, relatively few of these treatments are widely used in everyday clinical practice, and their level of benefit may not be ideal, particularly in practice contexts and when compared to usual clinical care. THESIS These limitations may be due, in part, to a mismatch between focal treatment design and the young people treated in real-world clinical care, who are diagnostically heterogeneous, and very frequently present with comorbidity. Improved fit may be achieved via transdiagnostic treatment approaches designed to address multiple disorders and problems, if these approaches can retain the benefits of manualization and the substantive clinical strength that has generated empirical support to date. SCOPE Here we review the evolution of empirically-based youth psychotherapy from focal treatment manuals toward transdiagnostic approaches, and we describe and illustrate three transdiagnostic treatment strategies: (a) a core dysfunction approach, (b) a common elements and modular design approach, and (c) a principle-guided approach. CLINICAL APPLICATIONS We complement research findings with a clinical perspective based on our use of manual-guided transdiagnostic intervention in clinical care settings, and we propose directions for research and practice.
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Affiliation(s)
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
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87
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Abstract
Purpose
The purpose of this paper is to provide a critical perspective on the international evidence on promoting young people’s social and emotional well-being in schools. The challenges of integrating evidence-based interventions within schools are discussed and the need for innovative approaches to research and practice are considered in order to support more sustainable approaches that can be embedded into the everyday practice of school systems.
Design/methodology/approach
A common elements approach to intervention development and implementation is explored. A case study is presented on piloting this approach with post-primary students, based on consultations with students and teachers concerning their needs in supporting youth social and emotional well-being.
Findings
The integration and sustainability of evidence-based social and emotional skills programmes within the context of whole school systems is far from clearly established. Research on the use of a common elements approach to evidence-based treatment and youth prevention programmes is presented and the application of this method to the development and implementation of social and emotional learning interventions is considered. Preliminary case study findings are presented exploring this approach in school-based intervention development for post-primary school students.
Research limitations/implications
The potential of adopting a common elements approach is considered; however, more rigorous research is needed to identify the most potent strategies for social and emotional skills development.
Originality/value
Identifying a common set of evidence-based strategies for enhancing adolescents’ social and emotional skills could lead to innovative approaches to intervention delivery that would extend the impact and reach of evidence-based practice across diverse educational systems and school settings.
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88
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Lau A, Barnett M, Stadnick N, Saifan D, Regan J, Wiltsey Stirman S, Roesch S, Brookman-Frazee L. Therapist report of adaptations to delivery of evidence-based practices within a system-driven reform of publicly funded children's mental health services. J Consult Clin Psychol 2017; 85:664-675. [PMID: 28471210 PMCID: PMC5501960 DOI: 10.1037/ccp0000215] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined clinical adaptations reported by community therapists to multiple evidence-based practices (EBPs) currently implemented in children's mental health services. Based on an item set informed by Stirman and colleagues' model (2015), 2 factors emerged describing Augmenting adaptations and Reducing/Reordering adaptations. We used multilevel modeling to examine therapist- and practice-level predictors of therapist reports of each type of adaptation. METHOD Data were drawn from an online survey, including a novel therapist report measure of EBP adaptations, completed by 572 therapists (89.2% female, Mage = 37.08 years, 33.4% non-Hispanic White) delivering EBPs in the context of a system-driven, fiscally mandated implementation effort. RESULTS Analyses revealed that the 2 types of therapist adaptations (Augmenting and Reducing/Reordering) could be readily discriminated, with therapists reporting significantly more Augmenting than Reducing/Reordering adaptations. Therapists of Hispanic/Latino ethnicity and with fewer years of experience reported more extensive Augmenting adaptations, but no therapist background characteristics were associated with Reducing/Reordering adaptations. Therapists' general attitudes that EBPs diverged from their personal approach to therapy were associated with reporting more Augmenting and Reducing/Reordering adaptations. In contrast, negative perceptions toward the specific EBP predicted Reducing/Reordering adaptations, but not Augmenting adaptations. CONCLUSIONS Community therapist reports suggest that most adaptations undertaken involve engaging with the practice to augment the fit of the EBPs for local contexts; however, when practices were perceived negatively, therapists were more likely to make adaptations reducing or rearranging components. (PsycINFO Database Record
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Affiliation(s)
- Anna Lau
- Department of Psychology, University of California, Los Angeles
| | - Miya Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara
| | - Nicole Stadnick
- Department of Psychiatry, Child and Adolescent Services Research Center, University of California, San Diego
| | - Dana Saifan
- Department of Psychology, University of California, Los Angeles
| | | | | | - Scott Roesch
- Department of Psychology, San Diego State University
| | - Lauren Brookman-Frazee
- Department of Psychiatry, Child and Adolescent Services Research Center, University of California, San Diego
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Hogue A, Bobek M, Dauber S, Henderson CE, McLeod BD, Southam-Gerow MA. Distilling the Core Elements of Family Therapy for Adolescent Substance Use: Conceptual and Empirical Solutions. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2017; 26:437-453. [PMID: 30705581 DOI: 10.1080/1067828x.2017.1322020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This article describes several barriers to widespread dissemination of manualized family-based treatments for adolescent substance use (ASU). We then offer a highly promising solution for adopting and sustaining family therapy in usual care: distilling the core practice elements of empirically validated family therapy models for ASU. We present a conceptual distillation of family therapy for ASU grounded in existing observational fidelity measures for three manualized models, a process that yielded four core elements: Family Engagement, Relational Reframing, Family Behavior Change, and Family Restructuring. We then introduce an innovative empirical method for distilling core elements that can serve as a template for rigorous distillation of other treatment approaches. Finally, we discuss how core elements can enhance family therapy services within the diverse workforce of usual care for ASU.
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Affiliation(s)
- Aaron Hogue
- National Center on Addiction and Substance Abuse
| | - Molly Bobek
- National Center on Addiction and Substance Abuse
| | - Sarah Dauber
- National Center on Addiction and Substance Abuse
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90
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Edmunds JM, Brodman DM, Ringle VA, Read KL, Kendall PC, Beidas RS. Examining adherence to components of cognitive-behavioral therapy for youth anxiety after training and consultation. PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2017; 48:54-61. [PMID: 28603339 PMCID: PMC5461966 DOI: 10.1037/pro0000100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The present study examined 115 service providers' adherence to components of cognitive-behavioral therapy (CBT) for youth anxiety prior to training, post workshop training, and after three months of weekly consultation. Adherence was measured using a role-play with a trained actor. We examined differences in individual adherence to CBT components across time and the relationship between number of consultation sessions attended and adherence ratings following consultation. Findings indicated that somatic arousal identification and relaxation were the most used treatment components prior to training. Adherence to all components of CBT increased following workshop training, except the usage of problem-solving. Adherence to problem-solving, positive reinforcement, the identification of anxious self-talk, and the creation of coping thoughts increased following consultation but usage of problem-solving remained low compared to other treatment components. Overall adherence remained less than optimal at the final measurement point. Number of consultation sessions attended predicted post-consultation adherence to identification of somatic arousal, identification of anxious self-talk, and positive reinforcement. Implications include tailoring future training based on baseline levels of adherence and spending more time during training and consultation on underutilized CBT components, such as problem-solving. Limitations of the present study, including how adherence was measured, are discussed. This study adds to the implementation science literature by providing more nuanced information on changes in adherence over the course of training and consultation of service providers.
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Affiliation(s)
| | | | | | - Kendra L. Read
- Seattle Children’s Hospital, University of Washington School of Medicine
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92
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Espil FM, Elkin TD, Young J. Manualized and Modular Behavior Therapy for a Child With Tourette’s Disorder, Inattention, and Disruptive Behavior. Clin Case Stud 2016. [DOI: 10.1177/1534650116679732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Persistent tic disorders (PTDs), including Tourette’s Disorder (TD), involve motor and/or vocal tics and often cause significant impairment and distress for affected individuals and families. Functional impairment is typically greater among individuals with PTDs and comorbid disorders. The current gold standard behavioral intervention for tic disorders, Comprehensive Behavioral Intervention for Tics (CBIT), has demonstrated efficacy in randomized clinical trials. Complications introduced by comorbidities, however, potentially facilitate less optimal long-term outcomes using this treatment approach. This case study describes the implementation of CBIT and subsequent modularized parent training for an 8-year-old boy diagnosed with TD who also exhibited comorbid symptoms of inattention, hyperactivity, and oppositional behavior. Emphasis is placed on delineating treatment decisions, including the sequencing of specific techniques, in accord with algorithms for complicated PTD presentations discussed in the literature.
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Affiliation(s)
- Flint M. Espil
- Stanford University School of Medicine, Stanford, CA, USA
| | - T. David Elkin
- University of Mississippi Medical Center, Jackson, MS, USA
| | - John Young
- University of Mississippi, University Park, MS, USA
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93
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Park AL, Chorpita BF, Regan J, Weisz JR. Integrity of evidence-based practice: are providers modifying practice content or practice sequencing? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 42:186-96. [PMID: 24841745 DOI: 10.1007/s10488-014-0559-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examined patterns of evidence-based treatment (EBT) implementation within community settings by evaluating integrity along separate dimensions of practice content (PC; a session included the prescribed procedure) and practice sequencing (a session occurred in the prescribed sequence) within a recent randomized effectiveness trial. We measured whether sessions showed integrity to PC and to flexible or linear practice sequences. Findings revealed that providers tended to incorporate content from the EBT protocol in most treatment sessions, but that the sequencing of the sessions was often modified, suggesting that providers are amenable to evidence-based procedures, but not necessarily their prescribed arrangement.
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Affiliation(s)
- Alayna L Park
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095, USA,
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Bloomquist ML, Giovanelli A, Benton A, Piehler TF, Quevedo K, Oberstar J. Implementation and Evaluation of Evidence-Based Psychotherapeutic Practices for Youth in a Mental Health Organization. JOURNAL OF CHILD AND FAMILY STUDIES 2016; 25:3278-3292. [PMID: 30078979 PMCID: PMC6075715 DOI: 10.1007/s10826-016-0479-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The current initiative and program evaluation study is a demonstration of the research to practice process in youth-focused psychotherapy. We collaborated within a community-university partnership to create practice and research infrastructure in order to develop, implement, and evaluate two new models of service founded on evidence-based psychotherapeutic practice parameters. The two new service models incorporated validated interventions to address behavior problems in elementary age children, and depression in adolescents, which were delivered in separate but similarly run intensive outpatient programs within a mental health setting. We utilized a rigorous training, technical assistance, fidelity monitoring, and outcome measurement strategy to promote the integrity and quality of services provided. The resultant programs were delivered with acceptable to high fidelity and effects on youth and parenting measures collected during program and from pre to post showed a decrease in targeted problems in youth and positive benefits for families. This initiative and program evaluation adds to the accumulating research-to-practice literature in children's mental health.
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Affiliation(s)
- Michael L. Bloomquist
- Department of Psychiatry, University of Minnesota, F256/2B West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
- PrairieCare Medical Group, Minneapolis, MN, USA
| | - Alison Giovanelli
- Department of Psychiatry, University of Minnesota, F256/2B West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
| | - Anna Benton
- Department of Psychiatry, University of Minnesota, F256/2B West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
| | - Timothy F. Piehler
- Department of Family Social Science, University of Minnesota, 290 McNeal Hall, 1985 Buford Avenue, Saint Paul, MN 55108, USA
| | - Karina Quevedo
- Department of Psychiatry, University of Minnesota, F256/2B West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
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95
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Achenbach TM. Future Directions for Clinical Research, Services, and Training: Evidence-Based Assessment Across Informants, Cultures, and Dimensional Hierarchies. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:159-169. [DOI: 10.1080/15374416.2016.1220315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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96
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Abstract
Both theoretical and empirical findings have demonstrated similarities across diagnoses, leading to a growing interest in transdiagnostic interventions. Most of the evidence supporting transdiagnostic treatment has accumulated for depression, anxiety, and eating disorders, with minimal attention given to posttraumatic stress disorder and other reactions to traumatic stressors. Although single-diagnosis protocols are effective for posttraumatic stress disorder (PTSD) and other trauma-related disorders, in principle, transdiagnostic approaches may have beneficial applications within a traumatized population. This paper defines different types of transdiagnostic treatments, reviews transdiagnostic approaches used in related disorders, and discusses their applicability to PTSD. Examples are drawn from existing transdiagnostic treatments in order to provide a framework for the application of such interventions to the field of traumatic stress. Implications for implementation and dissemination are also discussed.
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Affiliation(s)
- Cassidy A Gutner
- National Center for PTSD, Women's Health Sciences Division, Boston University School of Medicine, 150 South Huntington Avenue, (116B-3), Boston, MA, 02130, USA.
| | - Tara Galovski
- National Center for PTSD, Women's Health Sciences Division, Boston University School of Medicine, 150 South Huntington Avenue, (116B-3), Boston, MA, 02130, USA
| | - Michelle J Bovin
- National Center for PTSD, Behavioral Science Division, Boston University School of Medicine, 150 South Huntington Avenue, (116B-3), Boston, MA, 02130, USA
| | - Paula P Schnurr
- National Center for PTSD, Executive Division, VA Medical Center (116D), Geisel School of Medicine at Dartmouth, 215 North Main St, White River Junction, VT, 05009, USA
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97
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Schmidt SJ, Schimmelmann BG. [Modular psychotherapy with children and adolescents]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 44:467-478. [PMID: 27356677 DOI: 10.1024/1422-4917/a000452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The implementation of evidence-based psychotherapy with children and adolescents has been limited so far. This is mainly due to the fact that patients in service settings tend to have higher rates of comorbidities and more frequently changing therapy needs than those in research settings. Thus, modular psychotherapies are promising, as they allow the treatment protocol to be adapted to patients’ individual needs. Because no review on modular psychotherapy for children and adolescents exists, we conducted a systematic literature research. The results of the 15 randomized controlled trials identified demonstrate that modular psychotherapy is associated with significant reductions in symptom levels as well as with higher rates of diagnostic remission compared to control conditions. Because of the lack of evidence, future studies should investigate the incremental efficacy of modular approaches and test the validity of underlying theoretical models as well as of decision flowcharts. Modular psychotherapy approaches have the potential to personalize evidence-based interventions for children and adolescents across various therapeutical traditions, and to facilitate their implementation into clinical practice.
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Affiliation(s)
- Stefanie J Schmidt
- 1 Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern
| | - Benno G Schimmelmann
- 1 Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern
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98
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Abstract
A growing number of Internet sites and mobile applications are being developed intended for use in clinical practice. However, during the development process (e.g., creating features and determining use cases), the needs and interests of providers are often overlooked. We explored providers' interests using a mixed-methods approach incorporating both qualitative and quantitative research methods. A first study used an interview approach to identify the challenges providers faced, tools they used, and any use of computers and apps specifically. Fifteen providers from both the United States and Canada completed the interview and recordings were transcribed and analyzed using a constructivist grounded theory approach. Four primary themes were identified including challenges, potential tools, access and usability. A second study used a brief survey completed by 132 providers at a large healthcare system to explore current use of and potential interest in Internet and mobile technologies. Although many providers (80.9%) reported recommending some form of technology to patients, this was mostly Internet websites that were predominantly informational/psychoeducational in nature. Overall, these studies combine to suggest a strong interest in websites and apps for use in clinical settings while highlighting potential areas (ease of use, patient security and privacy) that should be considered in the design and deployment of these tools.
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99
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Hersh J, Metz KL, Weisz JR. New Frontiers in Transdiagnostic Treatment: Youth Psychotherapy for Internalizing and Externalizing Problems and Disorders. Int J Cogn Ther 2016. [DOI: 10.1521/ijct.2016.9.2.140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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100
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Elkin TD, Sarver DE, Wong Sarver N, Young J, Buttross S. Future Directions for the Implementation and Dissemination of Statewide Developmental-Behavioral Pediatric Integrated Health Care. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:619-630. [PMID: 27210591 DOI: 10.1080/15374416.2016.1152551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The integration of mental health and pediatric health care services has long been a goal for both research and practice. With the advent of federal policies developed to mandate clinical efficiency across the health care spectrum, this issue is becoming more salient. Applied literature on this topic is only recently emerging, however, and there are limited contextual examples to guide program development, research, and refinement. This article presents background information relevant to the development of such a program (the Center for Advancement of Youth). The cultural and organizational contexts for the project are discussed, with particular emphasis on models for cooperation among several institutions of varying size and scope. The implications for the future of tangible research in this area are also discussed, with attention to extending lessons learned to diverse settings motivated to integrate various aspects of health care service provision.
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Affiliation(s)
- T David Elkin
- a Department of Psychiatry and Human Behavior , University of Mississippi Medical Center
| | - Dustin E Sarver
- b Department of Pediatrics , University of Mississippi Medical Center
| | - Nina Wong Sarver
- b Department of Pediatrics , University of Mississippi Medical Center
| | - John Young
- c Department of Psychology , University of Mississippi
| | - Susan Buttross
- b Department of Pediatrics , University of Mississippi Medical Center
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