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Peipert A, Adams S, Lorenzo-Luaces L. "I would not want the mechanic to direct me to an engine repair manual": a qualitative analysis of provider perspectives on low-intensity treatments for patients on waiting lists. BMC Psychiatry 2023; 23:600. [PMID: 37592212 PMCID: PMC10436418 DOI: 10.1186/s12888-023-05055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Low-intensity treatments (LITs), such as bibliotherapy or online self-help, have the potential to reach more individuals than traditional face-to-face care by circumventing many of the common barriers to mental health treatment. Despite substantial research evidence supporting their usability and efficacy across several clinical presentations, prior work suggests that mental health providers rarely recommend LITs for patients waiting for treatment. METHODS The present study analyzed provider open responses to a prompt asking about perceived barriers, thoughts, and comments related to additional treatment resources for patients on treatment waiting lists. We surveyed 141 practicing mental health providers, 65 of whom responded to an open text box with additional thoughts on using LITs for patients on treatment waiting lists. Responses were qualitatively coded using a thematic coding process. RESULTS Qualitative outcomes yielded 11 codes: patient appropriateness, research evidence, feasibility, patient barriers, liability, patient personal contact, additional resources, positive attitudes, trust in programs, systemic problems, and downplaying distress. CONCLUSIONS Results suggest providers are predominantly concerned about the potential of suggesting a LIT that would be ultimately inappropriate for their patient due to a lack of assessment of the patient's needs. Furthermore, providers noted ambiguity around the legal and ethical liability of recommending a LIT to someone who may not yet be a patient. Guidelines and standards for recommending LITs to patients on treatment waiting lists may help address ambiguity regarding their use in routine care.
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Affiliation(s)
- Allison Peipert
- Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E 10th Street, Bloomington, IN, 47405, USA
| | - Sydney Adams
- Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E 10th Street, Bloomington, IN, 47405, USA
| | - Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E 10th Street, Bloomington, IN, 47405, USA.
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2
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Abstract
Contingency management (i.e. rewarding people, often with money, for achieving their recovery goals) is backed by decades of empirical support yet remains highly underutilized. Rewards are rarely used in real-world clinical practice due to a number of concerns, including most notably, the apparent lack of innovation, as well as moral, philosophical, ethical, and economic concerns, and even federal rules meant to prevent illegal inducements in health care. Still, other opponents argue that some patients will try to "game" the system by simply doing whatever it takes to earn monetary rewards. This paper provides a succinct, up-to-date overview of the current evidence base for contingency management for opioid use disorder. Common barriers and solutions to implementation, as well as implications for future research and clinical practice are discussed. Although important, greater uptake of contingency management interventions is about more than legislation and regulations; it's about recognizing stigma, shaping attitudes, and increasing awareness. Provider involvement in advocacy efforts at all levels and collaboration involving academic-industry partnerships is necessary to advance the burgeoning digital health care space and improve outcomes for people with opioid use disorder. Key MessagesContingency management is highly effective but highly underutilized.Low uptake is largely attributed to a lack of innovation and moral, ethical, and economic concerns, among other barriers.Technology-enabled solutions and academic-industry partnerships are critical to advance opioid use disorder care.
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Affiliation(s)
- Steven L Proctor
- Thriving Mind South Florida, Miami, FL, USA.,PRO Health Group, Miami Beach, FL, USA.,Department of Psychiatry and Behavioral Health, Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
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3
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Schilling S, Orr CJ, Delamater AM, Flower KB, Heerman WJ, Perrin EM, Rothman RL, Yin HS, Sanders L. COVID-19 vaccine hesitancy among low-income, racially and ethnically diverse US parents. PATIENT EDUCATION AND COUNSELING 2022; 105:2771-2777. [PMID: 35393230 PMCID: PMC8966372 DOI: 10.1016/j.pec.2022.03.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/24/2022] [Accepted: 03/26/2022] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Examine factors impacting U.S. parents' intention to vaccinate their children against COVID-19. METHODS Data were collected February-May 2021 from parents living in six geographically diverse locations. The COVID-19 Exposure and Family Impact Survey assessed perceived susceptibility and severity to adverse outcomes from the pandemic. Semi-structured interviews assessed perceptions about benefits and risks of vaccinating children. RESULTS Fifty parents of 106 children (newborn-17 years) were included; half were Spanish-speaking and half English-speaking. 62% were hesitant about vaccinating their children against COVID-19. Efficacy and safety were the main themes that emerged: some parents perceived them as benefits while others perceived them as risks to vaccination. Parent hesitancy often relied on social media, and was influenced by narrative accounts of vaccination experiences. Many cited the lower risk of negative outcomes from COVID-19 among children, when compared with adults. Some also cited inaccurate and constantly changing information about COVID-19 vaccines. CONCLUSION Main drivers of parent hesitancy regarding child COVID-19 vaccination include perceived safety and efficacy of the vaccines and lower severity of illness in children. PRACTICE IMPLICATIONS Many vaccine-hesitant parents may be open to vaccination in the future and welcome additional discussion and data.
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Affiliation(s)
- Samantha Schilling
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Colin J Orr
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Kori B Flower
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Eliana M Perrin
- Department of Pediatrics, Johns Hopkins Schools of Medicine and Nursing, Baltimore, MD, USA.
| | - Russell L Rothman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - H Shonna Yin
- Departments of Pediatrics and Population Health, New York University School of Medicine, New York, USA.
| | - Lee Sanders
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
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4
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Klein AB, Kline AC, Bowling AR, Feeny NC. Bridging the science-practice gap in treatment for posttraumatic stress disorder: Testing strategies to enhance beliefs toward exposure therapy. J Clin Psychol 2021; 77:2765-2780. [PMID: 34273910 DOI: 10.1002/jclp.23221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/27/2021] [Accepted: 06/23/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Exposure therapies (e.g., prolonged exposure [PE]), are first-line interventions for posttraumatic stress disorder but remain underutilized, partially due to providers' negative beliefs about these interventions. We examined two experimental strategies aimed at enhancing beliefs towards PE and subsequent utilization. METHOD Clinicians (N = 155) were randomized to one of three conditions presenting a PE rationale: basic, empirically-based, or emotionally-based description. Participants were rerandomized to write or not write arguments for utilizing PE. Before and after PE rationales and 1-month later, participants completed questions about PE beliefs and utilization. RESULTS Participants reported small yet durable belief change across all rationale conditions, with greatest change following the empirically-based description. Across conditions, belief change was not impacted by writing condition or associated with utilization. CONCLUSION Addressing negative beliefs with empirical information may be a brief, cost-effective strategy to improve clinicians' beliefs toward PE. Complementary strategies that leverage belief modification to increase utilization are needed.
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Affiliation(s)
- Alexandra B Klein
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alexander C Kline
- Clinical Psychology, VA San Diego Healthcare System, San Diego, California, USA
| | - Alexandra R Bowling
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Norah C Feeny
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
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5
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Scott K, Jarman S, Moul S, Murphy CM, Yap K, Garner BR, Becker SJ. Implementation support for contingency management: preferences of opioid treatment program leaders and staff. Implement Sci Commun 2021; 2:47. [PMID: 33931126 PMCID: PMC8088083 DOI: 10.1186/s43058-021-00149-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/20/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Contingency management (CM), a behavioral intervention that provides incentives for achieving treatment goals, is an evidence-based adjunct to medication to treat opioid use disorder. Unfortunately, many front-line treatment providers do not utilize CM, likely due to contextual barriers that limit effective training and ongoing support for evidence-based practices. This study applied user-informed approaches to adapt a multi-level implementation strategy called the Science to Service Laboratory (SSL) to support CM implementation. METHODS Leaders and treatment providers working in community-based opioid treatment programs (OTPs; N = 43) completed qualitative interviews inquiring about their preferences for training and support implementation strategies (didactic training, performance feedback, and external facilitation). Our team coded interviews using a reflexive team approach to identify common a priori and emergent themes. RESULTS Leaders and providers expressed a preference for brief training that included case examples and research data, along with experiential learning strategies. They reported a desire for performance feedback from internal supervisors, patients, and clinical experts. Providers and leaders had mixed feelings about audio-recording sessions but were open to the use of rating sheets to evaluate CM performance. Finally, participants desired both on-call and regularly scheduled external facilitation to support their continued use of CM. CONCLUSIONS This study provides an exemplar of a user-informed approach to adapt the SSL implementation support strategies for CM scale-up in community OTPs. Study findings highlight the need for user-informed approaches to training, performance feedback, and facilitation to support sustained CM use in this setting.
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Affiliation(s)
- Kelli Scott
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA.
| | - Shelly Jarman
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Samantha Moul
- University of New Haven, 300 Boston Post Road, West Haven, CT, 06516, USA
| | - Cara M Murphy
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Kimberly Yap
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Bryan R Garner
- RTI International, 3040 E Cornwallis Rd, Durham, NC, 27709, USA
| | - Sara J Becker
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
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6
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Stewart RE, Wolk CB, Neimark G, Vyas R, Young J, Tjoa C, Kampman K, Jones DT, Mandell DS. It's not just the money: The role of treatment ideology in publicly funded substance use disorder treatment. J Subst Abuse Treat 2021; 120:108176. [PMID: 33298303 PMCID: PMC7808060 DOI: 10.1016/j.jsat.2020.108176] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 08/04/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022]
Abstract
Medications for opioid use disorder (MOUD) are a first-line treatment for opioid use disorder, yet national surveys indicate that most substance use treatment facilities do not offer MOUD. This article presents the results of a qualitative analysis of interviews with leaders from 25 treatment organizations in Philadelphia, Pennsylvania, that investigated attitudes and barriers toward MOUD. Most treatment organizations that we interviewed are adopting at least one MOUD, suggesting that Philadelphia exceeds the national average of organizations with MOUD capacity. Leaders indicated that both practical resources and ideological barriers thwart adoption and implementation of MOUD in publicly funded substance use disorder treatment agencies. Organizations that had recently adopted MOUDs revealed facilitators to MOUD adoption, such as strong leadership that champions the implementation to staff and redefining recovery from substance use disorders throughout the organization. This study's findings highlight that clients, clinicians, and leadership need to address both practical and ideological barriers to expanding MOUD use.
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Affiliation(s)
- Rebecca E Stewart
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Courtney Benjamin Wolk
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Ridhi Vyas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jordyn Young
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Tjoa
- Community Behavioral Health, Philadelphia, PA, USA
| | - Kyle Kampman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David T Jones
- Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
| | - David S Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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7
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Purtle J, Marzalik JS, Halfond RW, Bufka LF, Teachman BA, Aarons GA. Toward the data-driven dissemination of findings from psychological science. AMERICAN PSYCHOLOGIST 2020; 75:1052-1066. [PMID: 33252944 PMCID: PMC8182894 DOI: 10.1037/amp0000721] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The public health impact of psychological science is maximized when it is disseminated clearly and compellingly to audiences who can act on it. Dissemination research can generate knowledge to help achieve this, but dissemination is understudied in the field of implementation science. As a consequence, the designs of dissemination strategies are typically driven by anecdote, not evidence, and are often ineffective. We address this issue by synthesizing key theory and findings from consumer psychology and detailing a novel research approach for "data-driven dissemination." The approach has 3 parts: (a) formative audience research, which characterizes an audience's awareness about, adoption of, and attitudes toward an intervention, as well as preferences for receiving information about it; (b) audience segmentation research, which identifies meaningful subgroups within an audience to inform the tailoring of dissemination strategies; and (c) dissemination effectiveness research, which determines the strategies that are most effective. This approach is then illustrated using the dissemination of the American Psychological Association's (APA, 2017) Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults as a case study. Data are presented from a 2018-2019 survey of licensed APA-member psychologists who treat adults with PTSD (n = 407, response rate = 29.8%). We present survey findings on awareness about, attitudes toward, and adoption of the guideline and find significant differences across these domains between psychologists who do and do not regularly use clinical practice guidelines. We conclude by discussing future directions to advance dissemination research and practice. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Jacob S. Marzalik
- American Psychological Association, Washington, District of Columbia
| | - Raquel W. Halfond
- American Psychological Association, Washington, District of Columbia
| | - Lynn F. Bufka
- American Psychological Association, Washington, District of Columbia
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8
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Stewart RE, Beidas RS, Mandell DS. Stop Calling Them Laggards: Strategies for Encouraging Nonadopters to Incorporate Evidence-Based Practices. Psychiatr Serv 2019; 70:958-960. [PMID: 31242831 PMCID: PMC6995301 DOI: 10.1176/appi.ps.201900031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Diffusion theory has deeply influenced implementation science and, specifically, language and thinking around practitioners and organizations that do not adopt evidence-based practices. In this Open Forum, the authors address the use of the term "laggard" to characterize this late or nonadopting group and argue for new nomenclature and modernized attitudes and approaches toward this group.
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Affiliation(s)
- Rebecca E Stewart
- Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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9
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Powell BJ, Beidas RS, Rubin RM, Stewart RE, Wolk CB, Matlin SL, Weaver S, Hurford MO, Evans AC, Hadley TR, Mandell DS. Applying the Policy Ecology Framework to Philadelphia's Behavioral Health Transformation Efforts. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:909-926. [PMID: 27032411 DOI: 10.1007/s10488-016-0733-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Raghavan et al. (Implement Sci 3(26):1-9, 2008) proposed that effective implementation of evidence-based practices requires implementation strategies deployed at multiple levels of the "policy ecology," including the organizational, regulatory or purchaser agency, political, and social levels. However, much of implementation research and practice targets providers without accounting for contextual factors that may influence provider behavior. This paper examines Philadelphia's efforts to work toward an evidence-based and recovery-oriented behavioral health system, and uses the policy ecology framework to illustrate how multifaceted, multilevel implementation strategies can facilitate the widespread implementation of evidence-based practices. Ongoing challenges and implications for research and practice are discussed.
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Affiliation(s)
- Byron J Powell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105C McGavran-Greenberg Hall, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA. .,Department of Psychiatry, Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ronnie M Rubin
- Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
| | - Rebecca E Stewart
- Department of Psychiatry, Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Samantha L Matlin
- Thomas Scattergood Behavioral Health Foundation, Philadelphia, PA, USA
| | - Shawna Weaver
- Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
| | - Matthew O Hurford
- Community Care Behavioral Health Organization, Philadelphia, PA, USA
| | - Arthur C Evans
- Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
| | - Trevor R Hadley
- Department of Psychiatry, Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, PA, 19104, USA
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10
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Stewart RE, Adams DR, Mandell DS, Nangia G, Shaffer L, Evans AC, Rubin R, Weaver S, Hadley TR, Beidas RS. Non-participants in policy efforts to promote evidence-based practices in a large behavioral health system. Implement Sci 2017; 12:70. [PMID: 28545492 PMCID: PMC5445384 DOI: 10.1186/s13012-017-0598-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 05/08/2017] [Indexed: 11/18/2022] Open
Abstract
Background System-wide training initiatives to support and implement evidence-based practices (EBPs) in behavioral health systems have become increasingly widespread. Understanding more about organizations who do not participate in EBP training initiatives is a critical piece of the dissemination and implementation puzzle if we endeavor to increase access in community settings. Methods We conducted 30 1-h semi-structured interviews with leaders in non-participating agencies who did not formally participate in system-wide training initiatives to implement EBPs in the City of Philadelphia, with the goal to understand why they did not participate. Results We found that despite not participating in training initiatives, most agencies were adopting (and self-financing) some EBP implementation. Leadership from agencies that were implementing EBPs reported relying on previously trained staff to implement EBPs and acknowledged a lack of emphasis on fidelity. Most leaders at agencies not adopting EBPs did not have a clear understanding of what EBP is. Those familiar with EBPs in agencies not adopting EBPs reported philosophical objections to EBPs. When asked about quality assurance and treatment selection, leaders reported being guided by system audits. Conclusions While it is highly encouraging that many agencies are adopting EBPs on their own, significant questions about fidelity and implementation success more broadly remain.
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Affiliation(s)
- Rebecca E Stewart
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Danielle R Adams
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,School of Social Service Administration, University of Chicago, Chicago, IL, USA
| | - David S Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Gayatri Nangia
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lauren Shaffer
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Arthur C Evans
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA.,American Psychological Association, Washington, DC, USA
| | - Ronnie Rubin
- Community Behavioral Health, Philadelphia, PA, USA
| | | | - Trevor R Hadley
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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11
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Decker C, Garavalia L, Garavalia B, Gialde E, Yeh RW, Spertus J, Chhatriwalla AK. Understanding physician-level barriers to the use of individualized risk estimates in percutaneous coronary intervention. Am Heart J 2016; 178:190-7. [PMID: 27502869 DOI: 10.1016/j.ahj.2016.03.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 03/31/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND The foundation of precision medicine is the ability to tailor therapy based upon the expected risks and benefits of treatment for each individual patient. In a prior study, we implemented a software platform, ePRISM, to execute validated risk-stratification models for patients undergoing percutaneous coronary intervention and found substantial variability in the use of the personalized estimates to tailor care. A better understanding of physicians' perspectives about the use of individualized risk-estimates is needed to overcome barriers to their adoption. METHODS In a qualitative research study, we conducted interviews, in-person or by telephone, with 27 physicians at 8 centers that used ePRISM until thematic saturation occurred. Data were coded using descriptive content analyses. RESULTS Three major themes emerged among physicians who did not use ePRISM to support decision making: (1) "Experience versus Evidence," physicians' preference to rely upon personal experience and subjective assessments rather than objective risk estimates; (2) "Omission of Therapy," the perception that the use of risk models leads to unacceptable omission of potentially beneficial therapy; and (3) "Unnecessary Information," the opinion that information derived from risk models is not needed because physicians' decision making is already sound and they already know the information. CONCLUSIONS Barriers to the use of risk models in clinical practice include physicians' perceptions that their experience is sufficient, that models may lead to omission of therapy in patients that may benefit from therapy, and that they already provide good care. Anticipating and overcoming these barriers may improve the adoption of precision medicine.
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12
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Ng MY, Weisz JR. Annual Research Review: Building a science of personalized intervention for youth mental health. J Child Psychol Psychiatry 2016; 57:216-36. [PMID: 26467325 PMCID: PMC4760855 DOI: 10.1111/jcpp.12470] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Within the past decade, health care service and research priorities have shifted from evidence-based medicine to personalized medicine. In mental health care, a similar shift to personalized intervention may boost the effectiveness and clinical utility of empirically supported therapies (ESTs). The emerging science of personalized intervention will need to encompass evidence-based methods for determining which problems to target and in which order, selecting treatments and deciding whether and how to combine them, and informing ongoing clinical decision-making through monitoring of treatment response throughout episodes of care. We review efforts to develop these methods, drawing primarily from psychotherapy research with youths. Then we propose strategies for building a science of personalized intervention in youth mental health. FINDINGS The growing evidence base for personalizing interventions includes research on therapies adapted for specific subgroups; treatments targeting youths' environments; modular therapies; sequential, multiple assignment, randomized trials; measurement feedback systems; meta-analyses comparing treatments for specific patient characteristics; data-mining decision trees; and individualized metrics. CONCLUSION The science of personalized intervention presents questions that can be addressed in several ways. First, to evaluate and organize personalized interventions, we propose modifying the system used to evaluate and organize ESTs. Second, to help personalizing research keep pace with practice needs, we propose exploiting existing randomized trial data to inform personalizing approaches, prioritizing the personalizing approaches likely to have the greatest impact, conducting more idiographic research, and studying tailoring strategies in usual care. Third, to encourage clinicians' use of personalized intervention research to inform their practice, we propose expanding outlets for research summaries and case studies, developing heuristic frameworks that incorporate personalizing approaches into practice, and integrating personalizing approaches into service delivery systems. Finally, to build a richer understanding of how and why treatments work for particular individuals, we propose accelerating research to identify mediators within and across RCTs, to isolate mechanisms of change, and to inform the shift from diagnoses to psychopathological processes. This ambitious agenda for personalized intervention science, although challenging, could markedly alter the nature of mental health care and the benefit provided to youths and families.
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Affiliation(s)
- Mei Yi Ng
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
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13
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Powell BJ, Hausmann-Stabile C, McMillen JC. Mental health clinicians' experiences of implementing evidence-based treatments. JOURNAL OF EVIDENCE-BASED SOCIAL WORK 2013; 10:396-409. [PMID: 24066630 PMCID: PMC3824394 DOI: 10.1080/15433714.2012.664062] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Implementation research has tremendous potential to bridge the research-practice gap; however, we know more about barriers to evidence-based care than the factors that contribute to the adoption and sustainability of evidence-based treatments. In this qualitative study the authors explore the experiences of clinicians (N = 11) who were implementing evidence-based treatments, highlighting the factors that they perceived to be most critical to successful implementation. The clinicians' narratives reveal many leverage points that can inform administrators, clinical supervisors, and clinicians who wish to implement evidence-based treatments, as well as other stakeholders who wish to develop and test strategies for moving evidence-based treatments into routine care.
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Affiliation(s)
- Byron J Powell
- a George Warren Brown School of Social Work, Washington University , St. Louis , Missouri , USA
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14
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Powell BJ, McMillen JC, Hawley KM, Proctor EK. Mental health clinicians' motivation to invest in training: results from a practice-based research network survey. Psychiatr Serv 2013; 64:816-8. [PMID: 23903609 PMCID: PMC3870900 DOI: 10.1176/appi.ps.003602012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Little is known about why clinicians seek training or about their willingness to invest in it. METHODS Results from a Web-based survey of 318 clinicians in a practice-based research network were used to examine factors that motivate clinicians to seek training or forgo training ("deal breakers") and their willingness to invest time and money in training. RESULTS Clinicians desired training that teaches advanced versus basic clinical skills, that covers an area they see as central to the needs of their clients, and that provides continuing education credit. Training that requires clinical supervision or the use of a manualized intervention was not a deal breaker for most clinicians. However, the amount of time and money most clinicians reported being willing to invest in training fell far short of the requirements for learning most evidence-based treatments. CONCLUSIONS Training strategies that combine high intensity with lower cost may be needed.
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Affiliation(s)
- Byron J Powell
- Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
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Stewart RE, Stirman SW, Chambless DL. A Qualitative Investigation of Practicing Psychologists' Attitudes Toward Research-Informed Practice: Implications for Dissemination Strategies. ACTA ACUST UNITED AC 2012; 43:100-109. [PMID: 22654246 DOI: 10.1037/a0025694] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article presents the results of a qualitative analysis of interviews with 25 psychologists in independent practice, investigating everyday treatment decisions and attitudes about treatment outcome research and empirically supported treatments (ESTs). Clinicians noted positive aspects about treatment outcome research, such as being interested in what works. However, they had misgivings about the application of controlled research findings to their practices, were skeptical about using manualized protocols, and expressed concern that nonpsychologists would use EST lists to dictate practice. Clinicians reported practicing in an eclectic framework, and many reported including cognitive-behavioral elements in their practice. To improve their practice, they reported valuing clinical experience, peer networks, practitioner-oriented books, and continuing education when it was not too basic. Time and financial barriers concerned nearly all participants. Clinicians suggested they might be interested in ESTs if they could integrate them into their current frameworks, and if resources for learning ESTs were improved.
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