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Johnson JE, Hailemariam M, Zlotnick C, Richie F, Sinclair J, Chuong A, Stirman SW. Mixed Methods Analysis of Implementation of Interpersonal Psychotherapy (IPT) for Major Depressive Disorder in Prisons in a Hybrid Type I Randomized Trial. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 47:410-426. [PMID: 31797190 DOI: 10.1007/s10488-019-00996-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article describes a mixed methods evaluation of implementation of interpersonal psychotherapy (IPT) in the first fully-powered trial of any treatment for major depressive disorder in an incarcerated population. Assessments in this Hybrid Type I trial included surveys of prison providers and administrators (n = 71), measures of feasibility and acceptability to prison patients (n = 90), and a planned document review (n = 460) to assess potential determinants of implementation. Quantitative and qualitative results indicated that IPT was a good fit for prisoners, and that prisoners and providers were enthusiastic about IPT. Providers were open to feedback, open to learning evidence-based practices, and committed to helping their clients. Limited treatment staff and variable supervision and collegial support may pose implementation challenges. For widespread prison implementation, scalable models for ongoing IPT training and supervision are needed.
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Affiliation(s)
- Jennifer E Johnson
- Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA. .,Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Room 366, Flint, MI, 48502, USA.
| | - Maji Hailemariam
- Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA
| | - Caron Zlotnick
- Butler Hospital and Brown University, 345 Blackstone Blvd, Providence, RI, 02906, USA.,University of Cape Town, Cape Town, South Africa
| | - Fallon Richie
- Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA
| | - Joshua Sinclair
- Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA
| | - Adam Chuong
- Brown University, 700 Butler Dr, Providence, RI, 02906, USA
| | - Shannon Wiltsey Stirman
- Dissemination and Training Division, Department of Psychiatry and Behavioral Sciences, National Center for PTSD, Stanford University, 795 Willow Road (NC-PTSD 334), Menlo Park, CA, 94025, USA
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152
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Park AL, Becker KD, Boustani MM, Chorpita BF. Decision-Making in Mental Health Care: Measuring Provider and Supervisor Use of Evidence. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 47:344-356. [PMID: 31728777 DOI: 10.1007/s10488-019-00989-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Use of evidence to inform clinical decisions has been shown to improve the quality and effectiveness of services. This study piloted an observational coding system for understanding providers and supervisors' use of evidence in their clinical decision-making. The Action Cycle and Use of Evidence Behavioral Observation Coding System (ACE-BOCS) is based on Graham et al. (Contin Educ Health Prof 26:13-24, 2006) conceptual framework for knowledge management, which articulates a sequence relevant to integrating evidence into decisions and actions, including identifying and selecting a problem and choosing, planning, and rehearsing a solution or action. Using the ACE-BOCS, two coders rated the extensiveness with which evidence was used to inform decisions made in clinical supervision sessions. In these clinical supervision sessions, supervisor-provider dyads discussed cases (N = 30; age range 8-19 years; 80% Latino/a or Hispanic ethnicity) that were identified as potentially being at risk for low treatment engagement in school mental health services. Results indicated that the ACE-BOCS can reliably and validly measure use of evidence and distinguish between strategic and indiscriminate use of evidence. The ACE-BOCS has value and utility for studying use of evidence, as it incorporates multiple actions related to service delivery and has the potential to be adapted for other aspects of mental healthcare decision-making beyond clinical supervision, as well as decision making within fields outside of mental health.
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Affiliation(s)
- Alayna L Park
- Department of Psychology, University of California, Los Angeles, Box 951563, Los Angeles, CA, 90095, USA
| | | | | | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, Box 951563, Los Angeles, CA, 90095, USA.
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153
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Implementing Motivational Interviewing for Substance Misuse on Medical Inpatient Units: a Randomized Controlled Trial. J Gen Intern Med 2019; 34:2520-2529. [PMID: 31468342 PMCID: PMC6848470 DOI: 10.1007/s11606-019-05257-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/28/2019] [Accepted: 07/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND General medical hospitals provide care for a disproportionate share of patients who misuse substances. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance misuse. OBJECTIVE To determine the effectiveness of three strategies for implementing motivational interviewing for substance misuse with general medical inpatients. DESIGN Type 3 hybrid effectiveness-implementation randomized controlled trial (Clinical Trials.gov: NCT01825057). PARTICIPANTS Thirty-eight providers (physicians, physician assistants, nurses) from 13 general medical inpatient services, and 1173 of their patients admitted to an academically affiliated acute care hospital. INTERVENTIONS Implementation strategies included (1) a continuing medical education workshop on detection of substance misuse and provision of a motivational interview; (2) workshop plus bedside supervision (apprenticeship condition); and (3) a workshop plus ability to place a medical order for an interview from a consultation-liaison service (consult condition). MAIN MEASURES Primary outcomes were the percentage of study-eligible patients who received an interview for substance misuse and the integrity (adherence, competence) of the interviews. The secondary outcome was the percent of patient statements within the interviews that indicated motivation for reducing substance misuse. KEY RESULTS 20.5% of patients in the consult condition received an interview, compared to 0.8% (Hedge's g = 1.49) and 3.0% (Hedge's g = 1.26) in the respective workshop only and apprenticeship conditions (p < 0.001). Motivational interviews in the consult condition were performed with more fundamental motivational interviewing adherence and competence than the other conditions. Most statements made by patients during the interviews favored reducing substance misuse, with no differences between conditions. CONCLUSIONS Providers' ability to place an order to have experts from the consultation-liaison service deliver a motivational interview was a more effective implementation strategy than a workshop or apprenticeship method for ensuring motivational interviewing is available to medical inpatients who misuse substances. TRIAL REGISTRY NCT01825057.
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154
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Nagy GA, LeMaire K, Miller ML, Howard M, Wyatt K, Zerubavel N. Development and Implementation of a Multicultural Consultation Service Within an Academic Medical Center. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2019.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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155
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Kiluk BD, Ray LA, Walthers J, Bernstein M, Tonigan JS, Magill M. Technology-Delivered Cognitive-Behavioral Interventions for Alcohol Use: A Meta-Analysis. Alcohol Clin Exp Res 2019; 43:2285-2295. [PMID: 31566787 PMCID: PMC6824956 DOI: 10.1111/acer.14189] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) has long-standing evidence for efficacy in the treatment of alcohol use, yet implementation in clinical practice has been challenging. Delivery of CBT through technology-based platforms, such as web-based programs and mobile applications, has the potential to provide widespread access to this evidence-based intervention. While there have been reviews indicating the efficacy of technology-based delivery of CBT for various psychiatric conditions, none have focused on efficacy for alcohol use. The current meta-analysis was conducted to fill this research gap. METHODS Descriptive data were used to characterize the nature of the literature on technology-delivered, CBT-based interventions for alcohol use ("CBT Tech"). Inverse-variance-weighted effect sizes were calculated, and random effects, effect sizes were pooled in 4 subgroups. RESULTS Fifteen published trials conducted primarily with at-risk or heavy drinkers were identified. Of these studies, 60% explicitly targeted alcohol use moderation. The content of CBT Tech programs varied, ranging from 4 to 62 sessions/exercises, with many programs combining elements of motivational interviewing (47%). With respect to efficacy, CBT Tech as a stand-alone treatment in contrast to a minimal treatment control showed a positive and statistically significant, albeit small effect (g = 0.20: 95% CI = 0.22, 0.38, kes = 5). When CBT Tech was compared to treatment as usual (TAU), effects were nonsignificant. However, when CBT Tech was tested as an addition to TAU, in contrast to TAU only, the effect size was positive, significant (g = 0.30: 95% CI = 0.10, 0.50, kes = 7), and stable over 12-month follow-up. Only 2 studies compared CBT Tech to in-person CBT, and this pooled effect size did not suggest superior efficacy. CONCLUSIONS These results show a benefit for technology-delivered, CBT-based interventions as a stand-alone therapy for heavy drinking or as an addition to usual care in specialty substance use settings.
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Affiliation(s)
| | - Lara A. Ray
- University of California at Los Angeles, Los Angeles, CA
| | - Justin Walthers
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI
| | - Michael Bernstein
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI
| | | | - Molly Magill
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI
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156
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157
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Jensen-Doss A, Smith AM, Walsh LM, Mora Ringle V, Casline E, Patel Z, Shaw AM, Maxwell C, Hanson R, Webster R. Preaching to the Choir? Predictors of Engagement in a Community-Based Learning Collaborative. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 47:10.1007/s10488-019-00985-4. [PMID: 31617139 DOI: 10.1007/s10488-019-00985-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study examined predictors of engagement among 283 professionals from 34 agencies participating in three community-based learning collaboratives (CBLCs) on trauma-focused cognitive-behavioral therapy (TF-CBT). Only 50.2% of participants completed the CBLC, primarily due to not attending consultation calls or completing training cases. While higher engagement was associated with being trauma-informed and using more of the TF-CBT components prior to the CBLC, most predictors were not significant, perhaps due to ceiling effects. Positive attitudes and high organizational support were not sufficient to ensure engagement. Future research using longitudinal measurement of a wider range of predictors is needed.
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Affiliation(s)
- Amanda Jensen-Doss
- University of Miami, Coral Gables, USA.
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA.
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158
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Pantazakos T. Treatment for whom? Towards a phenomenological resolution of controversy within autism treatment. STUDIES IN HISTORY AND PHILOSOPHY OF BIOLOGICAL AND BIOMEDICAL SCIENCES 2019; 77:101176. [PMID: 31003862 DOI: 10.1016/j.shpsc.2019.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 02/17/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Abstract
Autism's mainstream, behavioural treatment has recently faced allegations from neurodiversity activists, who claim that behaviourism is methodologically faulted and in serious breach of patient consent and human rights. In the present paper, I delve into this mounting controversy to suggest, contra behaviourism, that people with autism diagnoses do not just display a divergent set of behaviours, but should be seen to operate in 'worlds' different to those in typical neurological conditions. To philosophically accommodate this difference in 'worlds' and to utilise it in thinking about treatment orientation, I use Edmund Husserl's concept of the life-world (lebenswelt). I proffer that the autistic life-worlds should be used as the basis of treatment evaluation. I suggest that phenomenological ways of approaching autism, currently understudied, should be further developed and that behavioural treatment should be accordingly 'filtered' to accommodate the autistic life-worlds, and with them certain criticisms from neurodiversity.
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Affiliation(s)
- Themistoklis Pantazakos
- University College London, Department of Science and Technology Studies, Gower Street, London, WC1E 6BT, United Kingdom.
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159
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Lyon AR, Cook CR, Locke J, Davis C, Powell BJ, Waltz TJ. Importance and feasibility of an adapted set of implementation strategies in schools. J Sch Psychol 2019; 76:66-77. [PMID: 31759470 PMCID: PMC6876555 DOI: 10.1016/j.jsp.2019.07.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 03/03/2019] [Accepted: 07/25/2019] [Indexed: 11/22/2022]
Abstract
Implementation strategies are methods or techniques used to enhance the adoption, implementation, and sustainment of a new program or practice. Recent studies have facilitated implementation strategy prioritization by mapping strategies based on their feasibility and importance, but these efforts have not been replicated across distinct service delivery contexts. The aim of the current project was to evaluate the feasibility and importance of an education-adapted taxonomy of implementation strategies and to directly compare feasibility and importance ratings to the original Expert Recommendations for Implementing Change (ERIC) taxonomy, the leading compilation of implementation strategies in healthcare. A sample of 200 school-based consultants who support social, emotional, and mental health services provided ratings of feasibility and importance for each of the 75 strategies included in the adapted School Implementation Strategies, Translating ERIC Resources (SISTER) compilation. Results identified strategies rated as: (a) both feasible and important, (b) important but not feasible, (c) feasible but not important, and (d) neither feasible nor important. When mapped onto scatterplots using feasibility and importance ratings, comparison of ERIC and SISTER ratings indicated that approximately one third of the strategies shifted from one quadrant of the feasibility and importance axis to another. Findings demonstrate the value of efforts to adapt and generalize existing implementation products to novel service settings, such as schools. Additionally, findings assist implementation researchers and practitioners in prioritizing the selection of actionable and practically relevant implementation strategies to advance the quality of school mental health services.
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Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, United States of America.
| | - Clayton R Cook
- University of Minnesota, 250 Education Sciences Bldg, 56 East River Road, Minneapolis, MN 55455, United States of America.
| | - Jill Locke
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, United States of America.
| | - Chayna Davis
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, United States of America.
| | - Byron J Powell
- University of North Carolina at Chapel Hill, 1105C McGavran-Greenberg Hall, Campus Box 7411, 135 Dauer Drive, Chapel Hill, NC 27599, United States of America.
| | - Thomas J Waltz
- Eastern Michigan University, 900 Oakwood St., Ypsilanti, MI 48197, United States of America.
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160
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Wright J, Foster A, Cooper C, Sprange K, Walters S, Berry K, Moniz-Cook E, Loban A, Young TA, Craig C, Dening T, Lee E, Beresford-Dent J, Thompson BJ, Young E, Thomas BD, Mountain G. Study protocol for a randomised controlled trial assessing the clinical and cost-effectiveness of the Journeying through Dementia (JtD) intervention compared to usual care. BMJ Open 2019; 9:e029207. [PMID: 31519673 PMCID: PMC6747651 DOI: 10.1136/bmjopen-2019-029207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 08/09/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Services are being encouraged to provide postdiagnostic treatment to those with dementia but the availability of evidence-based interventions following diagnosis has not kept pace with increase in demand. To address this need, the Journeying through Dementia (JtD) intervention was created. A randomised controlled trial (RCT), based on a pilot study, is in progress. METHODS AND ANALYSIS The RCT is a pragmatic, two-arm, parallel group trial designed to test the clinical and cost-effectiveness of JtD compared with usual care. Recruitment will be through NHS services, third sector organisations and Join Dementia Research. The sample size is 486 randomised (243 to usual care and 243 to the intervention usual care). Participants can choose to ask a friend or relative (supporter) to become involved in the study. The primary outcome measure for participants is Dementia-Related Quality of Life (DEMQOL), collected at baseline and at 8 months' postrandomisation. Secondary outcome measures will be collected from participants and supporters at those visits. Participants will also be followed up at 12 months' postrandomisation with a reduced set of measures. A process evaluation will be conducted through qualitative and fidelity substudies. Analyses will compare the two arms of the trial on an intention to treat as allocated basis. The primary analyses will compare the mean DEMQOL scores of the participants at 8 months between the two study arms. A cost-effectiveness analysis will consider the incremental cost per Quality Adjusted Life Years of the intervention compared with usual care. Qualitative and fidelity substudies will be analysed through framework analysis and fidelity assessment tools respectively. ETHICS AND DISSEMINATION REC and HRA approval were obtained. A Data Monitoring and Ethics Committee has been constituted. Dissemination will be via publications, conferences and social media. Intervention materials will be made open access. TRIAL REGISTRATION NUMBER ISRCTN17993825.
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Affiliation(s)
- Jessica Wright
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Alexis Foster
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy Cooper
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Research Unit, The University of Nottingham, Nottingham, UK
| | - Stephen Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Esme Moniz-Cook
- Faculty of Health Sciences, Department of Psychological Heath and Well Being, The University of Hull, Hull, UK
| | - Amanda Loban
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Tracey Anne Young
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Claire Craig
- Art & Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Tom Dening
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ellen Lee
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Julie Beresford-Dent
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Benjamin John Thompson
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Emma Young
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Benjamin David Thomas
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Gail Mountain
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
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161
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Cucciare MA, Marchant K, Lindsay J, Craske MG, Ecker A, Day S, Hogan J, Henn J, LeBeau RT, Rabalais A, Rose RD, Qualls M, Treanor M, Abraham TH. An Evidence-Based Model for Disseminating-Implementing Coordinated Anxiety Learning and Management in Department of Veterans Affairs' Community-Based Outpatient Clinics. J Rural Health 2019; 36:371-380. [PMID: 31508861 DOI: 10.1111/jrh.12398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/20/2019] [Accepted: 08/20/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To explore the feasibility and utility of using a workshop, and supervision-consultation plus external facilitation to disseminate and implement cognitive-behavioral therapy in Veterans Affairs (VA) community-based outpatient clinics (CBOCs). METHODS This study occurred in the context of a randomized controlled trial aimed at comparing 2 methods for implementing Coordinated Anxiety Learning Management (CALM) in VA CBOCs. A 3-phase (workshop, supervision-consultation, external facilitation) model was used to support 32 VA CBOC mental health providers in learning and adopting CALM in their clinical practice. Qualitative data describe training activities and the feasibility and utility of each training phase in addressing challenges to adopting CALM. FINDINGS All 3 phases of the model were feasible to use with our sample of CBOC mental health providers. Providers reported challenges learning CALM during the workshop and concerns about not having enough training post-workshop to use CALM in practice. Providers primarily utilized supervision-consultation to tailor CALM to their practice, including learning how to prioritize a target disorder, "switch" the focus of treatment to a different disorder when comorbidities were present, and modify CALM sessions to fit shorter treatment visits. Providers primarily utilized external facilitation to further tailor CALM to their practice through implementation (eg, concrete help) and support-oriented help. Key lessons for implementing CALM in CBOCs are presented and discussed. CONCLUSIONS Findings provide initial evidence for the feasibility and utility of using each component of a facilitation-enhanced training model to promote CBOC VA providers' implementation of a computer and manual version of CALM in their practice.
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Affiliation(s)
- Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, Arkansas.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,VA South Central Mental Illness Research, Education and Clinical Center, North Little Rock, Arkansas
| | - Kathy Marchant
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, Arkansas
| | - Jan Lindsay
- Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Michelle G Craske
- Department of Psychology, University of California-Los Angeles, Los Angeles, California.,Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, California.,Department of Psychology, Anxiety and Depression Research Center, University of California-Los Angeles, Los Angeles, California
| | - Anthony Ecker
- Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Stephanie Day
- Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Julianna Hogan
- Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Jeremy Henn
- VA Texas Valley Coastal Bend Health Care System, Harlingen, Texas
| | - Richard T LeBeau
- Department of Psychology, University of California-Los Angeles, Los Angeles, California.,Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, California
| | | | - Raphael D Rose
- Department of Psychology, University of California-Los Angeles, Los Angeles, California
| | - Mason Qualls
- Harvard South Shore Psychiatry Residency Training Program, Brockton, Massachusetts.,Boston VA Healthcare System, Boston, Massachusetts
| | - Michael Treanor
- Department of Psychology, Anxiety and Depression Research Center, University of California-Los Angeles, Los Angeles, California
| | - Traci H Abraham
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, Arkansas.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,VA South Central Mental Illness Research, Education and Clinical Center, North Little Rock, Arkansas
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162
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Stanhope V, Ross A, Choy-Brown M, Jessell L. A Mixed Methods Study of Organizational Readiness for Change and Leadership During a Training Initiative Within Community Mental Health Clinics. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 46:678-687. [PMID: 31218480 PMCID: PMC6689447 DOI: 10.1007/s10488-019-00946-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This longitudinal mixed-methods study explored variation in organizational readiness for change and leadership behavior across seven organizations during a 12-month training initiative in person-centered care planning. Quantitative data was used to examine trajectories of organizational readiness for change and leadership behavior over time and qualitative data explored provider perspectives on the trajectory of these organizational factors during the 12-month training initiative. Findings indicated that levels of organizational readiness for change and leadership behavior varied across clinics, but most experienced a significant positive change at the mid-point of the training. Organizational readiness for change was positively correlated with leaderships behaviors across time. Provider focus group findings gave insight into their initial resistance to adopting the new practice and their increasing receptivity in the second 6 months due to increased understanding of the practice and leadership endorsement. Increasing provider openness to a new practice prior to training and having a consistently engaged leadership have the potential to improve the efficiency of a training initiative.
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Affiliation(s)
- Victoria Stanhope
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA.
| | - Abigail Ross
- Graduate School of Social Service, Fordham University, New York, USA
| | - Mimi Choy-Brown
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
- School of Social Work, University of Minnesota, Minneapolis, USA
| | - Lauren Jessell
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
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163
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Eiraldi R, McCurdy B, Schwartz B, Wolk CB, Abraham M, Jawad AF, Nastasi BK, Mautone JA. Pilot Study for the Fidelity, Acceptability and Effectiveness of a PBIS Program plus Mental Health Supports in Under-resourced Urban Schools. PSYCHOLOGY IN THE SCHOOLS 2019; 56:1230-1245. [PMID: 33981121 DOI: 10.1002/pits.22272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper describes implementation (fidelity, perceived acceptability) and tier 1 and tier 2 outcomes of a school-wide positive behavior interventions and supports approach (PBIS) including mental health supports at tier 2 in two K-8 urban schools. Interventions for tier 2 consisted of three manualized group cognitive behavioral therapy (GCBT) protocols for externalizing behavior problems, depression and anxiety. tier 1 and tier 2 interventions were implemented with fidelity but program feasibility for tier 2 was in question because school personnel needed a great deal of external support in order to implement the interventions. tier 1 interventions were associated with a decrease in office discipline referrals. Students participating in GCBT showed a significant decrease in mental health diagnostic severity at post-treatment. A discussion of perceived and actual implementation barriers and how they were addressed is provided. Implications for practice in low-income urban schools are discussed.
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Affiliation(s)
| | | | | | | | | | - Abbas F Jawad
- University of Pennsylvania Perelman School of Medicine
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164
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Bina R, Glasser S, Honovich M, Levinson D, Ferber Y. Nurses perceived preparedness to screen, intervene, and refer women with suspected postpartum depression. Midwifery 2019; 76:132-141. [DOI: 10.1016/j.midw.2019.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 05/16/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
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165
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Bearman SK, Bailin A, Terry R, Weisz JR. After the Study Ends: A Qualitative Study of Factors Influencing Intervention Sustainability. ACTA ACUST UNITED AC 2019; 51:134-144. [PMID: 32982034 DOI: 10.1037/pro0000258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sustaining evidence-based practices after initial training and support has ended is necessary to ensure lasting improvements in youth mental health services. This study examined factors impacting community clinicians' decisions to sustain a transdiagnostic youth intervention following participation in a study. The aim of the study was to identify potentially mutable factors impacting sustainability to inform future implementation efforts. Thirteen clinicians (85% women, 92% Caucasian, M age = 35.6) completed interviews after participating in an open trial of an evidence-based intervention for depression, anxiety, and conduct disorders. Interviews were analyzed using thematic analysis methods. All (100%) clinicians reported current use of the intervention. Four themes emerged related to sustainability. Clinicians (100%) reported that making modifications, alignment with prior training, and relative advantage influenced their current intervention use. Clinicians (100%) reported that knowledge transfer from treatment developers was vital to sustainability. They (92%) noted a number of logistical, inner-organizational, and client-level barriers to sustainability. Lastly, clinicians (92%) identified factors related to scaling up the intervention. A variety of personal, organizational, logistical, and client variables influence the sustainment of new interventions, and could be leveraged in future implementation efforts.
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166
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Brabson LA, Herschell AD, Kolko DJ, Mrozowski SJ. Associations Among Job Role, Training Type, and Staff Turnover in a Large-Scale Implementation Initiative. J Behav Health Serv Res 2019; 46:399-414. [PMID: 30607527 PMCID: PMC8006068 DOI: 10.1007/s11414-018-09645-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Staff turnover is problematic for behavioral health agencies implementing evidence-based practices (EBPs), which are costly and time-consuming. The current study examined the association between EBP training methods and turnover and explored predictors of turnover for different types of staff. Participants (100 clinicians, 50 supervisors, 50 administrators) were randomized to one of three training conditions for an EBP. Results indicated low annual rates of turnover for clinicians, supervisors, and administrators. However, contrary to hypothesis, no statistically significant differences were found in rates of turnover across training conditions. Partially consistent with prior research, organizational climate was a significant predictor of supervisor and administrator turnover at 24 months, but was not a significant predictor of clinician turnover. Implications and future directions for research are discussed.
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Affiliation(s)
- Laurel A Brabson
- Department of Psychology, West Virginia University, 1124 Life Sciences Building, P.O. Box 6040, Morgantown, WV, 26506-6040, USA.
| | - Amy D Herschell
- Department of Psychology, West Virginia University, 1124 Life Sciences Building, P.O. Box 6040, Morgantown, WV, 26506-6040, USA
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - David J Kolko
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, USA
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167
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Kemp CG, Petersen I, Bhana A, Rao D. Supervision of Task-Shared Mental Health Care in Low-Resource Settings: A Commentary on Programmatic Experience. GLOBAL HEALTH: SCIENCE AND PRACTICE 2019; 7:150-159. [PMID: 31249017 PMCID: PMC6641815 DOI: 10.9745/ghsp-d-18-00337] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 04/02/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Christopher G Kemp
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Inge Petersen
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Arvin Bhana
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa.,South African Medical Research Council, Health Systems Research Unit, Durban, South Africa
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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168
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Cunningham CE, Barwick M, Rimas H, Mielko S, Barac R. Modeling the Decision of Mental Health Providers to Implement Evidence-Based Children's Mental Health Services: A Discrete Choice Conjoint Experiment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:302-317. [PMID: 28918498 PMCID: PMC5809569 DOI: 10.1007/s10488-017-0824-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Using an online, cross sectional discrete choice experiment, we modeled the influence of 14 implementation attributes on the intention of 563 providers to adopt hypothetical evidence-based children’s mental health practices (EBPs). Latent class analysis identified two segments. Segment 1 (12%) would complete 100% of initial training online, devote more time to training, make greater changes to their practices, and introduce only minor modifications to EBPs. Segment 2 (88%) preferred fewer changes, more modifications, less training, but more follow-up. Simulations suggest that enhanced supervisor support would increase the percentage of participants choosing the intensive training required to implement EBPs. The dissemination of EBPs needs to consider the views of segments of service providers with differing preferences regarding EBPs and implementation process design.
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Affiliation(s)
- Charles E Cunningham
- Patient Centered Health Care, Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada.
| | - Melanie Barwick
- CHES Research Institute, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Heather Rimas
- Patient Centered Health Care, Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Stephanie Mielko
- Patient Centered Health Care, Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Raluca Barac
- Child and Youth Mental Health Research Unit, The Hospital for Sick Children, Toronto, Canada
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169
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McQuillin SD, Lyons MD, Becker KD, Hart MJ, Cohen K. Strengthening and Expanding Child Services in Low Resource Communities: The Role of Task-Shifting and Just-in-Time Training. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 63:355-365. [PMID: 30834554 DOI: 10.1002/ajcp.12314] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In the United States, the demand for child mental health services is increasing, while the supply is limited by workforce shortages. These shortages are unlikely to be corrected without significant structural changes in how mental health services are provided. One strategy for bridging this gap is task-shifting, defined as a process by which services that are typically delivered by professionals are moved to individuals with less extensive qualifications or training. Although task-shifting can increase the size of the workforce, there are challenges related to training new workers. In this paper, we propose Just-In-Time Training (JITT) as one strategy for improving task-shifting efforts. We define JITT as on-demand training experiences that only include what is necessary, when it is necessary, to promote competent service delivery. We offer a proof of concept from our own work shifting counseling and academic support tasks from school mental health professionals to pre-baccalaureate mentors, citing lessons learned during our iterative process of JITT development. We conclude with a series of key considerations for scaling up the pairing of task-shifting and JITT, including expanding the science of JITT and anticipating how task-shifting and JITT would work within the context of dynamic mental health service systems.
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Affiliation(s)
| | | | | | | | - Katie Cohen
- University of South Carolina, Columbia, SC, USA
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170
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Lyon AR, Cook CR, Duong MT, Nicodimos S, Pullmann MD, Brewer SK, Gaias LM, Cox S. The influence of a blended, theoretically-informed pre-implementation strategy on school-based clinician implementation of an evidence-based trauma intervention. Implement Sci 2019; 14:54. [PMID: 31146788 PMCID: PMC6543642 DOI: 10.1186/s13012-019-0905-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/16/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Individual-level implementation determinants, such as clinician attitudes, commonly influence the successful adoption of evidence-based practices, but few explicit strategies have been tested with regard to their ability to impact these key mechanisms of change. This paper reports on an initial test of a blended, theoretically informed pre-implementation strategy designed to target malleable individual-level determinants of behavior change. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a brief and pragmatic pre-implementation strategy that uses strategic education, social influence techniques, and group-based motivational interviewing to target implementation attitudes, perceived social norms, perceived behavioral control, and behavioral intentions to implement among mental health clinicians working in the education sector. METHODS As part of a pilot trial, 25 school mental health clinicians were randomized to BASIS (n = 12) or an attention control placebo (n = 13), with both conditions receiving training and consultation in an evidence-based intervention for youth experiencing trauma (the Cognitive Behavioral Intervention for Trauma in Schools). Theorized mechanisms of change (attitudes, perceived social norms, perceived behavioral control, and behavioral intentions) were assessed at baseline, post-training, and 4-month follow-up. Clinician participation in post-training consultation and intervention adoption were also tracked. RESULTS A series of regression models and independent sample t tests indicated that BASIS had significant, medium to large effects on the majority of its proximal mechanisms from baseline to post-training. BASIS was also associated with a greater latency between initial training in the intervention and discontinuation of participation in post-training consultation, with clinicians in the BASIS condition persisting in consultation for an average of 134 days versus 32 days for controls, but this difference was not statistically significant. At 4-month follow-up, most differences in the theorized mechanisms had attenuated, and approximately the same small number of BASIS clinicians adopted the trauma intervention as controls. CONCLUSION Findings suggest that the brief BASIS pre-implementation strategy had a significant influence on its proximal mechanisms of change, but that these changes did not persist over time or translate into adoption of the trauma intervention. Implications for theory refinement, revisions to the BASIS protocol, and next steps for research surrounding individual-level implementation strategies are discussed. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03791281 . Registered 31 December 2018-Retrospectively registered.
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Affiliation(s)
- Aaron R. Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Clayton R. Cook
- University of Minnesota, 250 Education Sciences Bldg, 56 East River Road, Minneapolis, MN 55455 USA
| | - Mylien T. Duong
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
- Committee for Children, 2815 2nd Ave #400, Seattle, WA 98121 USA
| | - Semret Nicodimos
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Michael D. Pullmann
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Stephanie K. Brewer
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Larissa M. Gaias
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Shanon Cox
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
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171
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Locke J, Violante S, Pullmann MD, Kerns SEU, Jungbluth N, Dorsey S. Agreement and Discrepancy Between Supervisor and Clinician Alliance: Associations with Clinicians' Perceptions of Psychological Climate and Emotional Exhaustion. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:505-517. [PMID: 29230606 DOI: 10.1007/s10488-017-0841-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite increasing interest in supervision as a leverage point for bolstering public mental health services, the potential influence of supervisory alliance on organizations and direct service providers remains understudied, particularly in the context of supporting evidence-based treatment (EBT) use. This study examined agreement and discrepancy between supervisor and clinician ratings of alliance associated with clinicians' perceptions of psychological climate and emotional exhaustion. Results indicated that discrepancies in alliance ratings were common and associated with clinicians' perceptions of psychological climate. These findings have important implications for collaboration among supervisors and clinicians within a community mental health organizational context and the provision of EBTs.
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Affiliation(s)
- Jill Locke
- University of Washington, 1417 NE 42nd St., Box 354875, Seattle, WA, 98105, USA.
| | | | - Michael D Pullmann
- University of Washington, 1417 NE 42nd St., Box 354875, Seattle, WA, 98105, USA
| | | | - Nathaniel Jungbluth
- University of Washington, 1417 NE 42nd St., Box 354875, Seattle, WA, 98105, USA
| | - Shannon Dorsey
- University of Washington, 1417 NE 42nd St., Box 354875, Seattle, WA, 98105, USA
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172
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Walker SC, Sedlar G, Berliner L, Rodriguez FI, Davis PA, Johnson S, Leith J. Advancing the state-level tracking of evidence-based practices: a case study. Int J Ment Health Syst 2019; 13:25. [PMID: 31007712 PMCID: PMC6457070 DOI: 10.1186/s13033-019-0280-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/25/2019] [Indexed: 01/21/2023] Open
Abstract
Background Despite a sustained focus by policymakers and researchers on improving the standard of clinical care in public mental health services, the use of evidence-based practice remains low. Among other challenges, this reflects the difficulty of translating clinical research into useable policy that can be feasibly funded and monitored by state or large healthcare systems. Case presentation In this paper we present a case study of Washington State’s strategy for monitoring the use of clinical elements at the session level for all Medicaid-funded children’s mental health services. The implementation of this strategy reflects policy actions to promote effective practice while also actively influencing multiple other levels of the implementation ecology. The approach is informed by the Policy Ecology Framework, the Consolidated Framework for Implementation Research, the evidence-based policymaking literature, and common ontology and clinical elements models. Conclusions We found the strategy developed in Washington State to be a feasible method of collecting session level information about the use of effective clinical mental health practices. In addition, the approach appears to be having influence on multiple layers of the implementation ecology that could be explored through further study.
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Affiliation(s)
- Sarah Cusworth Walker
- 1Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE Campus Parkway, Box 358015, Seattle, WA 98105 USA
| | - Georganna Sedlar
- 1Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE Campus Parkway, Box 358015, Seattle, WA 98105 USA
| | - Lucy Berliner
- Harborview Center for Sexual Assault and Trauma, 401 Broadway, Seattle, WA 98104 USA
| | - Felix I Rodriguez
- Washington State Health Care Authority, 626 8th Ave SE, Olympia, WA 98501 USA
| | - Paul A Davis
- Washington State Health Care Authority, 626 8th Ave SE, Olympia, WA 98501 USA
| | - Savannah Johnson
- 4Duke University, 2127 Campus Drive, Box 90065, Durham, NC 27708 USA
| | - Jessica Leith
- 1Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE Campus Parkway, Box 358015, Seattle, WA 98105 USA
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173
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Williams N, Beidas R. Annual Research Review: The state of implementation science in child psychology and psychiatry: a review and suggestions to advance the field. J Child Psychol Psychiatry 2019; 60:430-450. [PMID: 30144077 PMCID: PMC6389440 DOI: 10.1111/jcpp.12960] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Scientists have developed evidence-based interventions that improve the symptoms and functioning of youth with psychiatric disorders; however, these interventions are rarely used in community settings. Eliminating this research-to-practice gap is the purview of implementation science, the discipline devoted to the study of methods to promote the use of evidence-based practices in routine care. METHODS We review studies that have tested factors associated with implementation in child psychology and psychiatry, explore applications of social science theories to implementation, and conclude with recommendations to advance implementation science through the development and testing of novel, multilevel, causal theories. RESULTS During its brief history, implementation science in child psychology and psychiatry has documented the implementation gap in routine care, tested training approaches and found them to be insufficient for behavior change, explored the relationships between variables and implementation outcomes, and initiated randomized controlled trials to test implementation strategies. This research has identified targets related to implementation (e.g., clinician motivation, organizational culture) and demonstrated the feasibility of activating these targets through implementation strategies. However, the dominant methodological approach has been atheoretical and predictive, relying heavily on a set of variables from heuristic frameworks. CONCLUSIONS Optimizing the implementation of effective treatments in community care for youth with psychiatric disorders is a defining challenge of our time. This review proposes a new direction focused on developing and testing integrated causal theories. We recommend implementation scientists: (a) move from observational studies of implementation barriers and facilitators to trials that include causal theory; (b) identify a core set of implementation determinants; (c) conduct trials of implementation strategies with clear targets, mechanisms, and outcomes; (d) ensure that behaviors that are core to EBPs are clearly defined; and (e) agree upon standard measures. This agenda will help fulfill the promise of evidence-based practice for improving youth behavioral health.
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Affiliation(s)
| | - Rinad Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
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174
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Lindholm LH, Koivukangas A, Lassila A, Kampman O. What is important for the sustained implementation of evidence-based brief psychotherapy interventions in psychiatric care? A quantitative evaluation of a real-world programme. Nord J Psychiatry 2019; 73:185-194. [PMID: 30888233 DOI: 10.1080/08039488.2019.1582698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Behavioural activation and motivational interviewing, both evidence-based treatments (EBTs), were implemented in secondary psychiatric care. This longitudinal evaluation of a real-world programme focused on the penetration of EBT adoption and its associations with therapist-related and perceived intervention-related variables. The implementation plan was also compared to sub-processes of Normalization Process Theory. MATERIAL AND METHODS Six participating units employed 72 therapists regularly and they comprise the target group. Due to staff turnover, a total of 84 therapists were trained stepwise. Three survey points (q1, q2, q3) were set for a four-year cycle beginning a year after the initial training and completed 4-5 months after closing patient recruitment. The implementation plan included two workshop days, one for each EBT, and subsequent case consultation groups and other more general strategies. RESULTS Fifty-seven (68%) of programme-trained therapists responded to one or more of three questionnaires. The self-reported penetration covers about a third of the target group a few months after the completion of the programme. Therapists' favourable perceptions of the EBTs regarding relative advantage, compatibility and complexity were associated with their sustained adoption. Therapists' background factors (e.g. work experience) and positive adoption intention at q1 did not predict the actual adoption of the EBTs at q3. No specific sustainment strategies were included in the implementation plan. CONCLUSION Brief but multi-faceted training with subsequent case consultations promoted the adoption of EBTs in a real-world setting. Adding specific sustainment strategies to the implementation plan is proposed to ensure the long-term survival of the implementation outcomes.
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Affiliation(s)
- Lars H Lindholm
- a Department of Psychiatry , South Ostrobothnia Hospital District , Seinäjoki , Finland.,b Faculty of Medicine and Life Sciences , Tampere University , Tampere , Finland
| | - Antti Koivukangas
- a Department of Psychiatry , South Ostrobothnia Hospital District , Seinäjoki , Finland.,b Faculty of Medicine and Life Sciences , Tampere University , Tampere , Finland
| | - Antero Lassila
- a Department of Psychiatry , South Ostrobothnia Hospital District , Seinäjoki , Finland
| | - Olli Kampman
- a Department of Psychiatry , South Ostrobothnia Hospital District , Seinäjoki , Finland.,b Faculty of Medicine and Life Sciences , Tampere University , Tampere , Finland
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175
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Novoa-Gómez M, Córdoba-Salgado O, Rojas N, Sosa L, Cifuentes D, Robayo S. A Descriptive Analysis of the Interactions During Clinical Supervision. Front Psychol 2019; 10:669. [PMID: 30971991 PMCID: PMC6446000 DOI: 10.3389/fpsyg.2019.00669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 03/11/2019] [Indexed: 11/13/2022] Open
Abstract
This study intends to analyze some skills trained during supervision. In it we describe sets of interactions (based on the American Psychological Association [APA], 2006; competency domains) happened between the supervisor and the supervisee during the supervision process. Interactions from twelve supervisor-supervisee dyads during asynchronous and direct, and individual and group supervision sessions were video recorded for this purpose. The recordings helped to determine, classify, and define behavioral response classes in each dyad's interactions. Percentages of time spent in each behavior class were computed. A reliability of 95% CI [0.91, 0.95] among observers was obtained. The behavior classes in which more time was spent were assessment, intervention, and conceptualization skills. Behavior classes in which less time was spent were related to emotional and interpersonal processes. These findings are discussed by linking the evidence-based theory on supervision with the time spent in each behavior class.
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Affiliation(s)
- Mónica Novoa-Gómez
- Faculty of Psychology, Fundación Universitaria Konrad Lorenz, Bogotá, Colombia
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176
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Smith RW, Altman JK, Meeks S, Hinrichs KL. Mental Health Care for LGBT Older Adults in Long-Term Care Settings: Competency, Training, and Barriers for Mental Health Providers. Clin Gerontol 2019; 42:198-203. [PMID: 29877759 DOI: 10.1080/07317115.2018.1485197] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To assess mental health providers' experience with LGBT older adults in long-term care (LTC) settings and perceived barriers to quality care. METHODS Providers (N = 57) completed an online survey on demographics and practice characteristics. They were also asked about: number of LGBT residents they've worked with, relevance of LGBT issues to their practice, preparedness, willingness to learn, hours of formal/informal training, and barriers to providing care to LGBT patients. RESULTS Respondents were 63% psychologists, 16% social workers, 14% psychiatrists, and 5% nurses, most of whom practiced in LTC consulting roles. Most providers felt working with LGBT issues was relevant to their practice and felt well-prepared and willing to learn, though they were unaware of evidence based practices (EBTs), especially for LTC settings. They had little coursework on LGBT issues, and identified lack of training, stigma, and residents concealing their identity as the greatest barriers to quality care. CONCLUSIONS Mental health providers in LTC facilities would benefit from more training in LGBT-specific mental health problems and evidence-based treatments, and efforts to destigmatize LGBT identities in these settings might improve access to mental health care. CLINICAL IMPLICATIONS LGBT-specific training and EBTs are needed. Facilities need to address stigma with residents and providers.
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Affiliation(s)
- Ronald W Smith
- a University of Louisville Department of Psychological and Brain Sciences , Louisville , KY.,b VA Boston Healthcare System , Boston , MA
| | - Jennifer K Altman
- a University of Louisville Department of Psychological and Brain Sciences , Louisville , KY.,c University of Washington School of Medicine , Seattle , WA
| | - Suzanne Meeks
- a University of Louisville Department of Psychological and Brain Sciences , Louisville , KY
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177
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Lyon AR, Bruns EJ. From evidence to impact: Joining our best school mental health practices with our best implementation strategies. SCHOOL MENTAL HEALTH 2019; 11:106-114. [PMID: 31709018 PMCID: PMC6839825 DOI: 10.1007/s12310-018-09306-w] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
There is substantial research evidence for the effectiveness of school mental health strategies across problem areas, developmental levels, and the prevention-intervention spectrum. At the same time, it is clear that the education and mental health fields continue to struggle to apply this evidence at any level of scale. This commentary reflects on ways in which education-specific applications of implementation science principles - and explicit consideration of determinants of implementation success - may guide more consistent use of evidence in school mental health. After reviewing implementation determinants and strategies across multiple levels of effect (i.e., the outer setting, inner setting, individual, and intervention levels), the commentary goes on to recommend specific areas of needed attention in school mental health implementation efforts and research. These include a need to adapt interventions to better fit the context of schools, streamlining school mental health programs and practices to make them more implementable, and recognizing the critical role of assessment and selection of evidence-based interventions by school leaders. The commentary concludes by reflecting on the substantial opportunity provided by the education sector to both apply and advance implementation science.
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178
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Jackson CB, Brabson LA, Quetsch LB, Herschell AD. Training transfer: a systematic review of the impact of inner setting factors. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:167-183. [PMID: 29922872 DOI: 10.1007/s10459-018-9837-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 06/01/2018] [Indexed: 06/08/2023]
Abstract
Consistent with Baldwin and Ford's model (Pers Psychol 41(1):63-105, 1988), training transfer is defined as the generalization of learning from a training to everyday practice in the workplace. The purpose of this review was to examine the influence of work-environment factors, one component of the model hypothesized to influence training transfer within behavioral health. An electronic literature search guided by the Consolidated Framework for Implementation Research's inner setting domain was conducted was conducted on Medline OVID, Medline EMBASE, and PsycINFO databases. Of 9184 unique articles, 169 full-text versions of articles were screened for eligibility, yielding 26 articles meeting inclusion criteria. Results from the 26 studies revealed that overall, having more positive networks and communication, culture, implementation climate, and readiness for implementation can facilitate training transfer. Although few studies have examined the impact of inner setting factors on training transfer, these results suggest organizational context is important to consider with training efforts. These findings have important implications for individuals in the broader health professions educational field.
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179
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Wolk CB, Stewart RE, Eiraldi R, Cronholm P, Salas E, Mandell DS. The implementation of a team training intervention for school mental health: Lessons learned. Psychotherapy (Chic) 2019; 56:83-90. [PMID: 30489095 PMCID: PMC6395502 DOI: 10.1037/pst0000179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Children obtain more mental health services through schools than through any other system. In urban, low-resource schools, mental health care often is provided by teams of contracted community mental health workers. Implementation of intended services may struggle in the context of challenges related to team functioning. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an efficacious approach for improving team functioning in health care. In collaboration with stakeholders, we adapted TeamSTEPPS for school mental health teams and pilot-tested it in 3 schools participating in an ongoing implementation of cognitive-behavioral therapy. In total, 3 teams randomized to receive TeamSTEPPS were compared with 3 teams who did not participate in TeamSTEPPS. Feasibility and acceptability of the adapted TeamSTEPPS and the impact on team skills and behavior were assessed through qualitative interviews and field notes and quantitatively over the course of 1 school year. In this article, we describe the process of adapting and implementing TeamSTEPPS. In addition to providing the researchers' perspective, we illustrate participant perspectives using qualitative data when possible. Key challenges included leader and staff turnover, logistical barriers (e.g., difficulty securing private space for qualitative interviews in schools), and navigating the protection of participant rights and autonomy given that prospective participants were employed by an agency with a vested interest in their participation. Concrete suggestions for overcoming challenges are provided to guide future research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Courtney Benjamin Wolk
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Rebecca E Stewart
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Ricardo Eiraldi
- Division of Developmental and Behavioral Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Peter Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania
| | | | - David S Mandell
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
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180
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Dissemination and Implementation of Cognitive Behavioral Therapy for Depression in the Kaiser Permanente Health Care System: Evaluation of Initial Training and Clinical Outcomes. Behav Ther 2019; 50:446-458. [PMID: 30824258 DOI: 10.1016/j.beth.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/11/2018] [Accepted: 08/12/2018] [Indexed: 11/22/2022]
Abstract
Notwithstanding its empirical status and strong recommendation in clinical practice guidelines, cognitive behavioral therapy (CBT) continues to be delivered infrequently and with low fidelity on the clinical front lines. Recently, organized efforts and policies within the public sector to disseminate and implement CBT and other evidence-based psychotherapies have yielded encouraging results and provided optimism for bridging the research-to-practice-gap. Following from these efforts, the current article examines the initial impact and experience of the implementation of an individualized approach to CBT training and treatment within the Kaiser Permanente health care system. Initial training outcomes, including changes in general and specific competencies, were assessed using divergent assessment methods within the initial cohort of therapists undergoing training. Initial patient outcomes, including changes in depression and anxiety, were assessed among patients receiving treatment from therapists in training. Results revealed training in and implementation of CBT-D was associated with overall large improvements in therapist competencies and in clinically significant improvements in both depression and anxiety among patients. Findings from the initial phase of dissemination and implementation within a large private system provide support for, and extend recent findings related to, the feasibility and effectiveness of training in and implementation of CBT-D in a real-world context.
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181
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Psychosocial Intervention Programs for Parents of Children with Cancer: A Systematic Review and Critical Comparison of Programs’ Models and Development. J Clin Psychol Med Settings 2019; 26:550-574. [DOI: 10.1007/s10880-019-09612-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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182
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Beidas RS, Volpp KG, Buttenheim AN, Marcus SC, Olfson M, Pellecchia M, Stewart RE, Williams NJ, Becker-Haimes EM, Candon M, Cidav Z, Fishman J, Lieberman A, Zentgraf K, Mandell D. Transforming Mental Health Delivery Through Behavioral Economics and Implementation Science: Protocol for Three Exploratory Projects. JMIR Res Protoc 2019; 8:e12121. [PMID: 30747719 PMCID: PMC6390186 DOI: 10.2196/12121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/19/2018] [Accepted: 10/20/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Efficacious psychiatric treatments are not consistently deployed in community practice, and clinical outcomes are attenuated compared with those achieved in clinical trials. A major focus for mental health services research is to develop effective and cost-effective strategies that increase the use of evidence-based assessment, prevention, and treatment approaches in community settings. OBJECTIVE The goal of this program of research is to apply insights from behavioral economics and participatory design to advance the science and practice of implementing evidence-based practice (EBP) for individuals with psychiatric disorders across the life span. METHODS Project 1 (Assisting Depressed Adults in Primary care Treatment [ADAPT]) is patient-focused and leverages decision-making heuristics to compare ways to incentivize adherence to antidepressant medications in the first 6 weeks of treatment among adults newly diagnosed with depression. Project 2 (App for Strengthening Services In Specialized Therapeutic Support [ASSISTS]) is provider-focused and utilizes normative pressure and social status to increase data collection among community mental health workers treating children with autism. Project 3 (Motivating Outpatient Therapists to Implement: Valuing a Team Effort [MOTIVATE]) explores how participatory design can be used to design organizational-level implementation strategies to increase clinician use of EBPs. The projects are supported by a Methods Core that provides expertise in implementation science, behavioral economics, participatory design, measurement, and associated statistical approaches. RESULTS Enrollment for project ADAPT started in 2018; results are expected in 2020. Enrollment for project ASSISTS will begin in 2019; results are expected in 2021. Enrollment for project MOTIVATE started in 2018; results are expected in 2019. Data collection had begun for ADAPT and MOTIVATE when this protocol was submitted. CONCLUSIONS This research will advance the science of implementation through efforts to improve implementation strategy design, measurement, and statistical methods. First, we will test and refine approaches to collaboratively design implementation strategies with stakeholders (eg, discrete choice experiments and innovation tournaments). Second, we will refine the measurement of mechanisms related to heuristics used in decision making. Third, we will develop new ways to test mechanisms in multilevel implementation trials. This trifecta, coupled with findings from our 3 exploratory projects, will lead to improvements in our knowledge of what causes successful implementation, what variables moderate and mediate the effects of those causal factors, and how best to leverage this knowledge to increase the quality of care for people with psychiatric disorders. TRIAL REGISTRATION ClinicalTrials.gov NCT03441399; https://www.clinicaltrials.gov/ct2/show/NCT03441399 (Archived by WebCite at http://www.webcitation.org/74dRbonBD). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12121.
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Affiliation(s)
- Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Kevin G Volpp
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.,Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA, United States.,Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States.,Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Alison N Buttenheim
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.,Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.,Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, United States
| | - Mark Olfson
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Melanie Pellecchia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca E Stewart
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Emily M Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Molly Candon
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Zuleyha Cidav
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Jessica Fishman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Annenberg School for Communication, University of Pennyslvania, Philadelphia, PA, United States
| | - Adina Lieberman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Kelly Zentgraf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Tackett JL, Brandes CM, King KM, Markon KE. Psychology's Replication Crisis and Clinical Psychological Science. Annu Rev Clin Psychol 2019; 15:579-604. [PMID: 30673512 DOI: 10.1146/annurev-clinpsy-050718-095710] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Despite psychological scientists' increasing interest in replicability, open science, research transparency, and the improvement of methods and practices, the clinical psychology community has been slow to engage. This has been shifting more recently, and with this review, we hope to facilitate this emerging dialogue. We begin by examining some potential areas of weakness in clinical psychology in terms of methods, practices, and evidentiary base. We then discuss a select overview of solutions, tools, and current concerns of the reform movement from a clinical psychological science perspective. We examine areas of clinical science expertise (e.g., implementation science) that should be leveraged to inform open science and reform efforts. Finally, we reiterate the call to clinical psychologists to increase their efforts toward reform that can further improve the credibility of clinical psychological science.
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Affiliation(s)
- Jennifer L Tackett
- Department of Psychology, Northwestern University, Evanston, Illinois 60208, USA;
| | - Cassandra M Brandes
- Department of Psychology, Northwestern University, Evanston, Illinois 60208, USA;
| | - Kevin M King
- Department of Psychology, University of Washington, Seattle, Washington 98195, USA
| | - Kristian E Markon
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa 52242, USA
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184
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The Factor Structure of the Cognitive Therapy Rating Scale (CTRS) in a Sample of Community Mental Health Clinicians. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-09998-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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185
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Coronado RA, Patel AM, McKernan LC, Wegener ST, Archer KR. Preoperative and postoperative psychologically informed physical therapy: A systematic review of randomized trials among patients with degenerative spine, hip, and knee conditions. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/jabr.12159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rogelio A. Coronado
- Department of Orthopaedic Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Akshita M. Patel
- Department of Orthopaedic Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Lindsey C. McKernan
- Department of Psychiatry and Behavioral Sciences; Vanderbilt University Medical Center; Nashville Tennessee
- Department of Physical Medicine and Rehabilitation; Vanderbilt University Medical Center; Nashville Tennessee
| | - Stephen T. Wegener
- Department of Physical Medicine and Rehabilitation; Johns Hopkins University; Baltimore Maryland
| | - Kristin R. Archer
- Department of Orthopaedic Surgery; Vanderbilt University Medical Center; Nashville Tennessee
- Department of Physical Medicine and Rehabilitation; Vanderbilt University Medical Center; Nashville Tennessee
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186
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Cho E, Wood PK, Taylor EK, Hausman EM, Andrews JH, Hawley KM. Evidence-Based Treatment Strategies in Youth Mental Health Services: Results from a National Survey of Providers. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 46:71-81. [PMID: 30209703 PMCID: PMC7357714 DOI: 10.1007/s10488-018-0896-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Previous surveys indicate infrequent use of evidence-based treatment (EBT) manuals in usual care youth mental health, but the extent to which providers use core and common EBT strategies and what contextual factors impact EBT strategy implementation need further study. In a national, multidisciplinary survey of 1092 youth-serving providers, providers reported regular use of many EBT strategies. Provider learning theory orientation, more recent degree, more standardized and ongoing assessment use, more positive attitudes toward innovation and evidence, fewer low-income clients, and perceptions that their agency valued quality care and provided fewer training resources predicted more frequent EBT strategy use.
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Affiliation(s)
- Evelyn Cho
- University of Missouri, Columbia, MO, 65211, USA.
| | | | - Erin K Taylor
- University of Missouri, Columbia, MO, 65211, USA
- University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Estee M Hausman
- University of Missouri, Columbia, MO, 65211, USA
- Stony Brook University, Stony Brook, USA
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187
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Maguire S, Li A, Cunich M, Maloney D. Evaluating the effectiveness of an evidence-based online training program for health professionals in eating disorders. J Eat Disord 2019; 7:14. [PMID: 31110761 PMCID: PMC6513519 DOI: 10.1186/s40337-019-0243-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/17/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Early detection and treatment are essential to ensuring the best possible health outcomes for people with eating disorders (EDs). However, low diagnostic accuracy and a lack of specific ED training are common workforce challenges in Australia and internationally. Online learning provides a potential solution in facilitating the access to evidence-based training programs. The InsideOut Institute has developed the first online clinical training program in EDs to assist with educating health professionals in the identification, assessment, and management of EDs. The aim of the study is to evaluate the effectiveness of the online training program, The Essentials, in mitigating barriers to health professionals treating patients with EDs. METHODS Pre and post training questionnaires assessed participants' attitudes, knowledge, and skills in relation to treating people with EDs. Demographic and work-related information (gender, discipline, work setting, practice length and remoteness) and participants' ratings of the online learning experience and satisfaction on completion were collected. The Wilcoxon signed rank test was applied to test for changes in learning outcomes before and after completion of the program. A multivariate linear regression model was estimated for each of the learning outcomes with personal and work-related characteristics as covariates. RESULTS Among 1813 health professionals who registered for The Essentials program between 1 October 2013 and 31 July 2018, 1160 completed at least 80% of the five learning modules. There were significant improvements in confidence, knowledge, skills to treat EDs and a reduction in stigmatised beliefs among the 480 participants who completed both pre and post assessments. Results from the regression models suggest that psychologists, dieticians, and those working in rural areas were more willing to treat EDs after completing the program. Additionally, those working in hospitals and regional or rural areas experienced the largest improvement in confidence for treating patients with EDs. CONCLUSIONS The Essentials program represents a new and effective way of meeting the educational needs of partaking health professionals working with ED patients. Greater investment in the development and testing of evidence-based online training programs for EDs may help to address some of the considerable workforce development challenges in EDs.
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Affiliation(s)
- Sarah Maguire
- 1InsideOut Institute, Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, 2006 NSW Australia
| | - Ang Li
- 2The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Sydney Health Economics, Sydney Local Health District, Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, 2006 NSW Australia
| | - Michelle Cunich
- 2The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Sydney Health Economics, Sydney Local Health District, Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, 2006 NSW Australia
| | - Danielle Maloney
- 1InsideOut Institute, Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, 2006 NSW Australia
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188
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Fenwick KM, Brimhall KC, Hurlburt M, Aarons G. Who Wants Feedback? Effects of Transformational Leadership and Leader-Member Exchange on Mental Health Practitioners' Attitudes Toward Feedback. Psychiatr Serv 2019; 70:11-18. [PMID: 30373496 PMCID: PMC6408302 DOI: 10.1176/appi.ps.201800164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to identify the mechanisms through which different aspects of leadership affect mental health practitioners' attitudes toward supervisory feedback. METHODS Data were collected from 363 practitioners nested in 68 treatment teams in public-sector mental health organizations. A multilevel path analysis was conducted to examine the associations of transformational leadership (supervisor's ability to inspire others to follow a course of action) and leader-member exchange (quality of the supervisor-practitioner relationship) with practitioner attitudes toward feedback. RESULTS Transformational leadership and leader-member exchange were directly and positively associated with practitioners' attitudes toward feedback. Transformational leadership was also indirectly associated with practitioners' attitudes toward feedback through the quality of supervisor-practitioner relationships. CONCLUSIONS Study results contribute to the growing body of evidence suggesting that leaders play a key role in shaping mental health service delivery. Both leadership behavior and high-quality supervisor-practitioner relationships are important in supporting practitioners in delivering evidence-based mental health care. Policymakers, administrators, and researchers should consider an integrative approach when developing leadership training interventions.
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Affiliation(s)
- Karissa M Fenwick
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Fenwick, Hurlburt); Child and Adolescent Services Research Center (Hurlburt, Aarons) and Department of Psychiatry (Aarons), University of California, San Diego; Department of Social Work, Binghamton University, State University of New York, Binghamton (Brimhall)
| | - Kim C Brimhall
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Fenwick, Hurlburt); Child and Adolescent Services Research Center (Hurlburt, Aarons) and Department of Psychiatry (Aarons), University of California, San Diego; Department of Social Work, Binghamton University, State University of New York, Binghamton (Brimhall)
| | - Michael Hurlburt
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Fenwick, Hurlburt); Child and Adolescent Services Research Center (Hurlburt, Aarons) and Department of Psychiatry (Aarons), University of California, San Diego; Department of Social Work, Binghamton University, State University of New York, Binghamton (Brimhall)
| | - Gregory Aarons
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Fenwick, Hurlburt); Child and Adolescent Services Research Center (Hurlburt, Aarons) and Department of Psychiatry (Aarons), University of California, San Diego; Department of Social Work, Binghamton University, State University of New York, Binghamton (Brimhall)
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189
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Wolitzky-Taylor K, Chung B, Bearman SK, Arch J, Grossman J, Fenwick K, Lengnick-Hall R, Miranda J. Stakeholder Perceptions of the Barriers to Receiving and Delivering Exposure-Based Cognitive Behavioral Therapy for Anxiety Disorders in Adult Community Mental Health Settings. Community Ment Health J 2019; 55:83-99. [PMID: 29508179 PMCID: PMC6123294 DOI: 10.1007/s10597-018-0250-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
CBT is considered the first-line treatment for anxiety disorders, particularly when it involves gradual confrontation with feared stimuli (i.e., exposure); however, delivery of CBT for anxiety disorders in real-world community clinics is lacking. This study utilized surveys we developed with key stakeholder feedback (patient, provider, and administrator) to assess patient and provider/administrator perceptions of the barriers to delivering (or receiving) CBT for anxiety disorders. Providers/administrators from two counties in California (N = 106) indicated lack of training/competency as primary barriers. Patients in one large county (N = 42) reported their own symptoms most often impacted treatment receipt. Both groups endorsed acceptability of exposure but indicated that its use in treatment provided/received had been limited. Implications and recommendations are discussed.
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Affiliation(s)
- Kate Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA.
- Department of Social Work, University of Southern California, Los Angeles, CA, USA.
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA.
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA.
| | - Bowen Chung
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Social Work, University of Southern California, Los Angeles, CA, USA
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
| | - Sarah Kate Bearman
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Social Work, University of Southern California, Los Angeles, CA, USA
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
| | - Joanna Arch
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Social Work, University of Southern California, Los Angeles, CA, USA
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
| | - Jason Grossman
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Social Work, University of Southern California, Los Angeles, CA, USA
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
| | - Karissa Fenwick
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Social Work, University of Southern California, Los Angeles, CA, USA
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
| | - Rebecca Lengnick-Hall
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Social Work, University of Southern California, Los Angeles, CA, USA
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Social Work, University of Southern California, Los Angeles, CA, USA
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
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190
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Burn M, Tully LA, Jiang Y, Piotrowska PJ, Collins DAJ, Sargeant K, Hawes D, Moul C, Lenroot RK, Frick PJ, Anderson V, Kimonis ER, Dadds MR. Evaluating Practitioner Training to Improve Competencies and Organizational Practices for Engaging Fathers in Parenting Interventions. Child Psychiatry Hum Dev 2019; 50:230-244. [PMID: 30078112 PMCID: PMC6428790 DOI: 10.1007/s10578-018-0836-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Fathers are consistently underrepresented in parenting interventions and practitioners are an important target for change in interventions to enhance father engagement. This research examined the effects of two practitioner training programs in improving practitioner rated competencies and organizational father-inclusive practices. Two studies were conducted, each with a single group, repeated measures (pre, post and 2-month follow-up) design. Study 1 (N = 233) examined the outcomes of face-to-face training in improving practitioner ratings of competencies in engaging fathers, perceived effectiveness and use of father engagement strategies, organizational practices and rates of father engagement. Study 2 (N = 356) examined online training using the same outcome measures. Practitioners in both training formats improved in their competencies, organizational practices and rates of father engagement over time, yet those in the online format deteriorated in three competencies from post-training to follow-up. The implications for delivering practitioner training programs to enhance competencies and rates of father engagement are discussed.
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Affiliation(s)
- M. Burn
- 0000 0004 1936 834Xgrid.1013.3School of Psychology, University of Sydney, Camperdown, NSW 2006 Australia
| | - L. A. Tully
- 0000 0004 1936 834Xgrid.1013.3School of Psychology, University of Sydney, Camperdown, NSW 2006 Australia
| | - Y. Jiang
- 0000 0004 1936 834Xgrid.1013.3School of Psychology, University of Sydney, Camperdown, NSW 2006 Australia
| | - P. J. Piotrowska
- 0000 0004 1936 834Xgrid.1013.3School of Psychology, University of Sydney, Camperdown, NSW 2006 Australia
| | - D. A. J. Collins
- 0000 0004 1936 834Xgrid.1013.3School of Psychology, University of Sydney, Camperdown, NSW 2006 Australia
| | - K. Sargeant
- 0000 0004 1936 834Xgrid.1013.3School of Psychology, University of Sydney, Camperdown, NSW 2006 Australia
| | - D. Hawes
- 0000 0004 1936 834Xgrid.1013.3School of Psychology, University of Sydney, Camperdown, NSW 2006 Australia
| | - C. Moul
- 0000 0004 1936 834Xgrid.1013.3School of Psychology, University of Sydney, Camperdown, NSW 2006 Australia
| | - R. K. Lenroot
- 0000 0004 4902 0432grid.1005.4School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052 Australia
| | - P. J. Frick
- 0000 0001 0662 7451grid.64337.35Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803 USA ,0000 0001 2194 1270grid.411958.0Learning Sciences Institute of Australia, Australian Catholic University, Brisbane, QLD 4000 Australia
| | - V. Anderson
- 0000 0000 9442 535Xgrid.1058.cRoyal Children’s Hospital, Murdoch Children’s Research Institute, Parkville, VIC 3052 Australia ,0000 0001 2179 088Xgrid.1008.9Department of Psychology, University of Melbourne, Parkville Campus, Melbourne, VIC 3010 Australia ,0000 0001 2179 088Xgrid.1008.9Department of Paediatrics, University of Melbourne, Parkville Campus, Melbourne, VIC 3010 Australia
| | - E. R. Kimonis
- 0000 0004 4902 0432grid.1005.4School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia
| | - M. R. Dadds
- 0000 0004 1936 834Xgrid.1013.3School of Psychology, University of Sydney, Camperdown, NSW 2006 Australia
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191
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Suchman NE, Borelli JL, DeCoste CL. Can addiction counselors be trained to deliver Mothering from the Inside Out, a mentalization-based parenting therapy, with fidelity? Results from a community-based randomized efficacy trial. Attach Hum Dev 2018; 22:332-351. [PMID: 30585532 DOI: 10.1080/14616734.2018.1559210] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study evaluated methods for training community-based clinicians to deliver a mentalization-based parenting intervention in an addiction treatment setting. Mothering from the Inside Out (MIO) targets psychological deficits associated with early stages of addiction recovery by fostering improvement in parental reflective functioning, the capacity to make sense of strong emotions in oneself and the child. Fifteen addiction counselors were randomized to training in MIO versus a Parent Education comparison, and completed eight training sessions and a clinically-supervised 12-session training case. As predicted, MIO and PE counselors demonstrated fidelity to their respective interventions during the training case. At the end of training, MIO counselors showed greater improvement than PE counselors in clinical reflective functioning, the capacity to make sense of a patients' mental and emotional experiences. Implications for training community-based counselors in evidence-based attachment interventions are explored.
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Affiliation(s)
- Nancy E Suchman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Yale Child Study Center, New Haven, CT, USA
| | - Jessica L Borelli
- Department of Psychological Science, University of California, Irvine, CA, USA
| | - Cindy L DeCoste
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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The Sustained Effects of CBT Training on Therapist Competence and Patient Outcomes. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9987-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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193
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Byrne A, Salmon P, Fisher P. A case study of the challenges for an integrative practitioner learning a new psychological therapy. COUNSELLING & PSYCHOTHERAPY RESEARCH 2018. [DOI: 10.1002/capr.12185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Angela Byrne
- Psychological Sciences; University of Liverpool; Liverpool UK
- Liverpool Psychology Cancer Service; Royal Liverpool and Broadgreen NHS Trust; Liverpool UK
| | - Peter Salmon
- Psychological Sciences; University of Liverpool; Liverpool UK
- Liverpool Psychology Cancer Service; Royal Liverpool and Broadgreen NHS Trust; Liverpool UK
| | - Peter Fisher
- Psychological Sciences; University of Liverpool; Liverpool UK
- Liverpool Psychology Cancer Service; Royal Liverpool and Broadgreen NHS Trust; Liverpool UK
- Nidaros; Østmarka University Hospital; Trondheim Norway
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194
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Pinto RM, Witte SS, Filippone P, Choi CJ, Wall M. Interprofessional Collaboration and On-the-Job Training Improve Access to HIV Testing, HIV Primary Care, and Pre-Exposure Prophylaxis (PrEP). AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:474-489. [PMID: 30966764 PMCID: PMC6460934 DOI: 10.1521/aeap.2018.30.6.474] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The HIV Continuum of Care is a global priority, yet vulnerable patients face access/retention challenges. Research is missing on the role social and public health service providers can play to help these patients. Using structural equation modeling, we examined the effects of interprofessional collaboration (IPC) and on-the-job training on the frequency of linkages to HIV testing, HIV primary care, and on pre-exposure prophylaxis (PrEP) psychoeducation. The sample included 285 New York City providers of social and public health services from 34 agencies. Forty-eight percent of providers had not offered PrEP psychoeducation and linked fewer than five patients to HIV testing and primary care per week. However, in multivariate analysis higher IPC was associated with more linkages and frequent psychoeducation. After adjusting for IPC, linkage training was associated with more frequent services. The influence of specific factors highlights areas for interventions and policies to improve access to the HIV Continuum of Care.
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Affiliation(s)
- Rogério M Pinto
- University of Michigan School of Social Work, Ann Arbor, Michigan
| | - Susan S Witte
- Columbia University School of Social Work, New York, New York
| | - Prema Filippone
- Columbia University School of Social Work, New York, New York
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195
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Kendall PC, Frank HE. Implementing evidence-based treatment protocols: Flexibility within fidelity. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018; 25:e12271. [PMID: 30643355 PMCID: PMC6329472 DOI: 10.1111/cpsp.12271] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Efficacious psychological treatments exist for a variety of mental health conditions, but many who could benefit from these treatments do not receive them. Increasing efforts have been made to disseminate effective protocols, and several approaches for implementing such treatments have been proposed, including the use of protocols, principles, practices, and policies. We discuss the relative merits of disseminating protocols, and highlight the importance of employing flexibility within fidelity. We describe the benefits of using protocols, including their empirical support, guidance for decision making, and structure to facilitate training and enhance treatment integrity. We also address several criticisms that have been offered against protocols, citing data that indicates that many of the criticisms are not warranted.
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196
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Asnaani A, Gallagher T, Foa EB. Evidence‐based protocols: Merits, drawbacks, and potential solutions. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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197
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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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198
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Pullmann MD, Lucid L, Harrison JP, Martin P, Deblinger E, Benjamin KS, Dorsey S. Implementation Climate and Time Predict Intensity of Supervision Content Related to Evidence Based Treatment. Front Public Health 2018; 6:280. [PMID: 30338253 PMCID: PMC6180155 DOI: 10.3389/fpubh.2018.00280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/11/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: Children infrequently receive evidence-based treatments (EBTs) for mental health problems due to a science-to-practice implementation gap. Workplace-based clinical supervision, in which supervisors provide oversight, feedback, and training on clinical practice, may be a method to support EBT implementation. Our prior research suggests that the intensity of supervisory focus on EBT (i.e., thoroughness of coverage) during workplace-based supervision varies. This study explores predictors of supervisory EBT intensity. Methods: Participants were twenty-eight supervisors and 70 clinician supervisees. They completed a baseline survey, and audio recorded supervision sessions over 1 year. Four hundred and thirty eight recordings were coded for supervision content. We chose to explore predictors of two EBT content elements due to their strong evidence for effectiveness and sufficient variance to permit testing. These included a treatment technique (“exposure”) and a method to structure treatment (“assessment”). We also explored predictors of non-EBT content (“other topics”). Mixed-effects models explored predictors at organizational/supervisor, clinician, and session levels. Results: Positive implementation climate predicted greater intensity of EBT content coverage for assessment (coefficient = 0.82, p = 0.004) and exposure (coefficient = 0.87, p = 0.001). Intensity of exposure coverage was also predicted by more time spent discussing each case (coefficient = 0.04, p < 0.001). Predictors of greater non-EBT content coverage included longer duration of supervision sessions (coefficient = 0.05, p < 0.001) and lower levels of supervisor EBT knowledge (coefficient = −0.17, p = 0.013). No other supervisor- or clinician-level variables were significant predictors in the mixed effects models. Conclusion: This was the first study to explore multi-level predictors of objectively coded workplace-based supervision content. Results suggest that organizations that expect, support and reward EBT are more likely to have greater intensity of EBT supervision coverage, which in turn may positively impact clinician EBT fidelity and client outcomes. There was evidence that supervisor knowledge of the EBT contributes to greater coverage, although robust supervisor and clinician factors that drive supervision are yet to be identified. Findings highlight the potential effectiveness of implementation strategies that simultaneously address organizational implementation climate and supervisor practices. More research is needed to identify mechanisms that support integration of EBT into supervision.
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Affiliation(s)
- Michael D Pullmann
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Leah Lucid
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Julie P Harrison
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Prerna Martin
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Esther Deblinger
- CARES Institute, Rowan University School of Osteopathic Medicine, Stratford, NJ, United States
| | | | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, United States
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199
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Stuart S, Schultz J, Ashen C. A New Community-Based Model for Training in Evidence-Based Psychotherapy Practice. Community Ment Health J 2018; 54:912-920. [PMID: 29396796 DOI: 10.1007/s10597-017-0220-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
It is critical that evidence-based practices (EBP's) be provided to patients. Efforts to train clinicians in the community in EBP's, however, has been hindered by a lack of resources and rigid and resource intensive models of training. We describe efforts to overcome these barriers in a large scale community-based training program for Interpersonal Psychotherapy implemented with over 1400 clinicians in Los Angeles working within the Los Angeles County Department of Mental Health public system of care. The program, described in detail, is a potential template for training for community-based clinicians in evidence-based psychotherapy practices.
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Affiliation(s)
- Scott Stuart
- University of Iowa, 1-293 Medical Education Building, Iowa City, IA, 52242, USA.
| | - Jessica Schultz
- Psychology Department, Augustana College, 639 38th Street, Rock Island, IL, 61201, USA
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200
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Watson DP, Ahonen EQ, Shuman V, Brown M, Tsemberis S, Huynh P, Ouyang F, Xu H. The housing first technical assistance and training (HFTAT) implementation strategy: outcomes from a mixed methods study of three programs. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2018; 13:32. [PMID: 30241546 PMCID: PMC6151066 DOI: 10.1186/s13011-018-0172-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/17/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND This paper discusses the initial testing of the Housing First Training and Technical Assistance (HFTAT) Program, a multifaceted, distance-based strategy for the implementation of the Housing First (HF) supportive housing model. HF is a complex housing intervention for serving people living with serious mental illness and a substance use disorder that requires significant individual- and structural-level changes to implement. As such, the HFTAT employs a combined training and consultation approach to target different levels of the organization. Training delivered to all organizational staff focuses on building individual knowledge and uses narrative storytelling to overcome attitudinal implementation barriers. Consultation seeks to build skills through technical assistance and fidelity audit and feedback. METHOD We employed a mixed method design to understand both individual-level (e.g., satisfaction with the HFTAT, HF knowledge acquisition and retention, and HF acceptability and appropriateness) and structural-level (e.g., fidelity) outcomes. Quantitative data were collected at various time points, and qualitative data were collected at the end of HFTAT activities. Staff and administrators (n = 113) from three programs across three states participated in the study. RESULTS Satisfaction with both training and consultation was high, and discussions demonstrated both activities were necessary. Flexibility of training modality and narrative storytelling were particular strengths, while digital badging and the community of practice were perceived as less valuable because of incompatibilities with the work context. HF knowledge was high post training and retained after 3-month follow-up. Participants reported training helped them better understand the model. Attitudes toward evidence-based interventions improved over 6 months, with qualitative data supporting this but demonstrating some minor concerns related to acceptability and appropriateness. Fidelity scores for all programs improved over 9 months. CONCLUSION The HFTAT was a well-liked and generally useful implementation strategy. Results support prior research pointing to the value of both (a) multifaceted strategies and (b) combined training and consultation approaches. The study also provides evidence for narrative storytelling as an approach for changing attitudinal implementation barriers. The need for compatibility between specific elements of an implementation strategy and the work environment was also observed.
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Affiliation(s)
- Dennis P Watson
- Center for Dissemination and Implementation Science, University of Illinois College of Medicine at Chicago, 1603 W Taylor St, Chicago, IL, 60612, USA.
| | - Emily Q Ahonen
- Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Valery Shuman
- Heartland Alliance Health, Midwest Harm Reduction Institute, 1207 W. Leland Ave, Chicago, IL, 60640, USA
| | - Molly Brown
- Department of Psychology, DePaul University, 1 E. Jackson, Chicago, IL, 60604, USA
| | - Sam Tsemberis
- Department of Psychiatry, NYPH, Columbia University Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Philip Huynh
- Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Fangqian Ouyang
- Indiana University School of Medicine, 340 W. 10th St, Indianapolis, IN, 46202, USA
| | - Huiping Xu
- Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
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