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Marriott BR, Andrews JH, Cho E, Tugendrajch SK, Hawley KM. Mental Health Provider Reach and Engagement in a Countywide Training Initiative. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:530-542. [PMID: 38351412 DOI: 10.1007/s10488-024-01345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 06/25/2024]
Abstract
Many training initiatives are underway to increase implementation of evidence-based practice (EBPs) in mental healthcare. However, little is known about what types of trainings and supports yield the highest reach and engagement. Supported by a tax-funded, countywide initiative to improve access to quality care for youths, the current mixed methods study evaluates mental health (MH) provider reach, or registering for the training initiative, and engagement, or participation in training activities, for several EBP training and implementation supports. MH providers were offered free 1) formal EBP workshops, 2) a biweekly learning community, 3) individual case consultation, and 4) confidential online clinical feedback system. To register, interested providers (N = 698) completed a web-based assessment measuring clinical practice information, organizational implementation climate, and EBP knowledge, attitudes, and practices. Thirteen providers, selected via purposeful sampling stratified by level of participation, completed semi-structured qualitative interviews. While the training initiative achieved high reach (66% of county agencies had a provider register), far fewer providers engaged substantially in training. Quantitative results indicated that providers whose professional discipline was not psychology, had higher baseline EBP knowledge, more extensive use of common evidence-based strategies, and less extensive use of other therapy strategies, engaged in more training. Rapid qualitative analysis of interviews expanded upon these findings and illuminated provider, organizational, system, practical, and training activity-specific barriers and facilitators to engagement. Findings suggest the importance of identifying strategies for improving provider engagement in training activities beyond workshops. Implications for future research and training initiatives are discussed.
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Affiliation(s)
- Brigid R Marriott
- Indiana University School of Medicine, Indianapolis, IN, USA.
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
| | | | | | | | - Kristin M Hawley
- University of Missouri, Columbia, MO, USA.
- Department of Psychological Sciences, University of Missouri, Columbia, MO, 65211, USA.
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Brown C, Lerner M, Stadheim J, Kerns C, Moskowitz L, Cohn E, Drahota A, Soorya L, Wainer A. Provider Self-Reported Use and Usefulness of Intervention Strategies for Externalizing Behaviors in Youths with ASD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023:1-15. [PMID: 37706638 PMCID: PMC10937329 DOI: 10.1080/15374416.2023.2251163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To examine predictors of implementation and perceived usefulness of four empirically supported strategies for treating externalizing behavior in youths with ASD. METHOD Participants were 557 providers in the United States with experience treating externalizing behavior in youths with ASD. Generalized estimating equations were used to determine whether self-reported use and usefulness of four empirically supported intervention strategies (functional communication training, functional behavior analysis, visual tools/supports, token economy) were predicted by key provider characteristics: professional discipline, experience, and practice specialization (across three indices) in ASD. Post-hoc contrasts were performed to identify provider groups reporting the greatest use and usefulness of the four strategies. RESULTS Strategies were most often used by providers with behavioral backgrounds, though perceived usefulness of strategies varied by providers' professional discipline. Compared to providers with more than 10 years of experience, less experienced providers endorsed the highest average use and usefulness of almost all strategies. Regarding ASD practice specialization, a lower volume of ASD cases, treating fewer youths with ASD over a 5-year period, and having a higher proportion of practice time working with youths with ASD reported were associated with greater use and usefulness of the strategies. CONCLUSIONS Empirically supported strategies are widely used by and perceived as useful by providers who treat youths with ASD and co-occurring externalizing behaviors. Use and usefulness varies based on provider discipline, experience, and ASD practice specialization.
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Affiliation(s)
| | | | - Jenna Stadheim
- Department of Educational Psychology, University of Nebraska-Lincoln
| | - Connor Kerns
- Department of Psychology, University of British Columbia
| | | | - Elizabeth Cohn
- Hunter-Bellevue School of Nursing, City University of New York
| | - Amy Drahota
- Department of Psychology, Michigan State University
| | - Latha Soorya
- Department of Psychiatry, Rush University Medical Center
| | - Allison Wainer
- Department of Psychiatry, Rush University Medical Center
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Liu MA, Brett EI, Chavarria J, King AC. Trying is believing: A pilot study of in-vivo nicotine replacement therapy sampling in disadvantaged Black adults who smoke cigarettes. Drug Alcohol Depend 2022; 241:109679. [PMID: 36332594 DOI: 10.1016/j.drugalcdep.2022.109679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION While nicotine replacement therapy (NRT) is a frontline tobacco treatment that doubles smoking quit rates, only about 18% of Black adults who smoke cigarettes report lifetime use of NRT. A promising approach for increasing NRT use is in-session (in-vivo) NRT sampling within cessation interventions. The present pilot study examined the effectiveness of an in-vivo NRT sampling intervention within a single-session, culturally-targeted motivational intervention trial in Black adults who smoke cigarettes. METHODS Non-treatment-seeking disadvantaged Black adults (N = 60) were offered the choice to sample nicotine lozenge, patch, or both in-session with the counselor present. Regardless of their choice, they were offered a one-week starter kit of both products. Data were analyzed at baseline and 1-month follow-up. Primary outcomes were 1) differences in motivation to quit smoking among NRT samplers versus non-samplers, 2) in-vivo NRT sampling preferences, and 3) in-vivo sampling's association with NRT use and improved smoking outcomes at follow up. RESULTS Almost all participants accepted a take-home NRT starter kit, and approximately half of those offered in-vivo sampling agreed to sample. Participants preferred sampling lozenges in session (75.8% lozenge only vs. 12.1% nicotine patch only or 12.1% both; p < .001). Motivation to quit smoking was not related to likelihood of in-vivo NRT sampling (p > .05). At 1-month follow-up, in-vivo samplers were more likely to use NRT (94% vs. 35%, respectively; p < .001) and report a quit attempt (81.8% vs. 53.9%, p < .05) compared to non-samplers. CONCLUSION In-vivo NRT sampling is a promising strategy to improve NRT uptake among Black adults who smoke cigarettes, regardless of motivation to quit smoking.
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Affiliation(s)
- Melissa A Liu
- Indiana University, Purdue University Indianapolis, USA.
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Sichel CE, Connors EH. Measurement feedback system implementation in public youth mental health treatment services: a mixed methods analysis. Implement Sci Commun 2022; 3:119. [PMID: 36415009 PMCID: PMC9682849 DOI: 10.1186/s43058-022-00356-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/28/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prior studies indicate the effectiveness of measurement-based care (MBC), an evidence-based practice, in improving and accelerating positive outcomes for youth receiving behavioral health services. MBC is the routine collection and use of client-reported progress measures to inform shared decision-making and collaborative treatment adjustments and is a relatively feasible and scalable clinical practice, particularly well-suited for under-resourced community mental health settings. However, uptake of MBC remains low, so information on determinants related to MBC practice patterns is needed. METHODS Quantitative and qualitative data from N = 80 clinicians who implemented MBC using a measurement feedback system (MFS) were merged to understand and describe determinants of practice over three study phases. Quantitative, latent class analysis identified clinician groups based on participants' ratings of MFS acceptability, appropriateness, and feasibility and describes similarities/differences between classes in clinician-level characteristics (e.g., age; perceptions of implementation climate; reported MFS use; phase I). Qualitative analyses of clinicians' responses to open-ended questions about their MFS use and feedback about the MFS and implementation supports were conducted separately to understand multi-level barriers and facilitators to MFS implementation (phase II). Mixing occurred during interpretation, examining clinician experiences and opinions across groups to understand the needs of different classes of clinicians, describe class differences, and inform selection of implementation strategies in future research (phase III). RESULTS We identified two classes of clinicians: "Higher MFS" and "Lower MFS," and found similarities and differences in MFS use across groups. Compared to Lower MFS participants, clinicians in the Higher MFS group reported facilitators at a higher rate. Four determinants of practice were associated with the uptake of MBC and MFS in youth-serving community mental health settings for all clinicians: clarity, appropriateness, and feasibility of the MFS and its measures; clinician knowledge and skills; client preferences and behaviors; and incentives and resources (e.g., time; continuing educational support). Findings also highlighted the need for individual-level implementation strategies to target clinician needs, skills, and perceptions for future MBC and MFS implementation efforts. CONCLUSION This study has implications for the adoption of evidence-based practices, such as MBC, in the context of community-based mental health services for youth.
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Affiliation(s)
- Corianna E Sichel
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University, 1051 Riverside Drive, Mail Unit 78, New York, NY, 10032, USA.
| | - Elizabeth H Connors
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, 389 Whitney Avenue, New Haven, CT, 06511, USA
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Maddalozzo M, Maddalozzo R. Utilization of Web-Based Training to Train Clinicians in the Prolonged Exposure Protocol. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2022. [DOI: 10.1080/15401383.2022.2142715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lackner JM, Jaccard J, Quigley BM, Ablove TS, Danforth TL, Firth RS, Gudleski GD, Krasner SS, Radziwon CD, Vargovich AM, Clemens JQ, Naliboff BD. Study protocol and methods for Easing Pelvic Pain Interventions Clinical Research Program (EPPIC): a randomized clinical trial of brief, low-intensity, transdiagnostic cognitive behavioral therapy vs education/support for urologic chronic pelvic pain syndrome (UCPPS). Trials 2022; 23:651. [PMID: 35964133 PMCID: PMC9375413 DOI: 10.1186/s13063-022-06554-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Urologic chronic pelvic pain syndrome (UCPPS) encompasses several common, costly, diagnoses including interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome that are poorly understood and inadequately treated with conventional medical therapies. Behavioral strategies, recommended as a first-line treatment for managing symptoms, are largely inaccessible, time and labor intensive, and technically complex. The Easing Pelvic Pain Interventions Clinical Research Program (EPPIC) is a clinical trial examining the efficacy of low-intensity cognitive behavioral therapy (Minimal Contact CBT or MC-CBT) for UCPPS and its durability 3 and 6 months post treatment. Additional aims include characterizing the operative processes (e.g., cognitive distancing, context sensitivity, coping flexibility, repetitive negative thought) that drive MC-CBT-induced symptom relief and pre-treatment patient variables that moderate differential response. Methods UCPPS patients (240) ages 18–70 years, any gender, ethnicity, and race, will be randomized to 4-session MC-CBT or a credible, non-specific education comparator (EDU) that controls for the generic effects from simply going to treatment. Efficacy assessments will be administered at pre-treatment, 2 weeks, and 3 and 6 months post treatment-week acute phase. A novel statistical approach applied to micro-analytic mediator assessment schedule will permit the specification of the most effective CBT component(s) that drive symptom relief. Discussion Empirical validation of a low-intensity self-management therapy transdiagnostic in scope has the potential to improve the health of chronic pelvic pain patients refractory to medical therapies, reduce social and economic costs, conserve health care resources, as well as inform evidence-based practice guidelines. Identification of change mechanisms and moderators of treatment effects can provide proactive patient-treatment matching fundamental to goals of personalized medicine. Trial Registration Clinicaltrials.gov NCT05127616. Registered on 9/19/21. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06554-9.
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Affiliation(s)
- Jeffrey M Lackner
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA.
| | - James Jaccard
- School of Social Work, New York University, New York, NY, USA.,Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Brian M Quigley
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Tova S Ablove
- Department of Obstetrics and Gynecology, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Teresa L Danforth
- Department of Urology, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Rebecca S Firth
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Gregory D Gudleski
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Susan S Krasner
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Christopher D Radziwon
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Alison M Vargovich
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | | | - Bruce D Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
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Milgram L, Freeman JB, Benito KG, Elwy AR, Frank HE. Clinician-Reported Determinants of Evidence-Based Practice Use in Private Practice Mental Health. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09551-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Meyer AE, Rodriguez-Quintana N, Miner K, Bilek EL, Vichich J, Smith SN, Koschmann E. Developing a statewide network of coaches to support youth access to evidence-based practices. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221101215. [PMID: 37091092 PMCID: PMC9924236 DOI: 10.1177/26334895221101215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: A national shortage of mental health providers for youth exists in the United States. Implementation support for mental health services in schools, where students are most likely to access care, can help to fill these gaps. Coaching consists of in vivo modeling and support during service delivery and is effective in supporting the implementation of evidence-based practices (EBPs). This implementation report describes the recruitment and training of community providers to become coaches as a part of a modified train-the-trainer model of implementation support. Method: An EBP implementation program, Transforming Research into Action to Improve the Lives of Students (TRAILS), trained community providers in Michigan to increase knowledge of cognitive behavioral therapy (CBT) and position them as coaches in schools. The development of the coach network involved five stages prior to the initiation of a randomized controlled trial: (1) recruitment, (2) a one-day clinical training, (3) 12 weeks of individualized consultation, (4) evaluation, and (5) training in the coaching protocol. Results: A total of 347 individuals attended an initial training, and 187 were paired with a consultant. Eighty-six clinicians from 47 of Michigan's 83 counties successfully became coaches by completing all required elements of training. Coaches showed significant improvements in the use and knowledge of CBT across consultation. Conclusion: Statewide networks of trained mental health professionals can address gaps in mental healthcare for youth. This article demonstrates one strategy for strengthening and leveraging community expertise to support the implementation of EPBs in schools. Plain Language Summary Although youth face many barriers in accessing effective mental health care, schools are one setting where they can more easily receive treatment. Research shows that training and supports are needed for school mental health professionals to provide effective care. Coaching, which involves in vivo support for school mental health professionals, is one helpful strategy. We describe the process of recruiting and training community clinicians to become coaches. The Transforming Research into Action to Improve the Lives of Students (TRAILS) program successfully recruited and trained a network of 86 community clinicians to become coaches. Clinicians attended two day-long trainings and participated in 12 weeks of personalized consultation. Clients to whom these clinicians provided CBT showed significant symptom improvement. Clinicians also reported that they increased their knowledge and use of core CBT strategies, including psychoeducation, exposure, and behavioral activation. Community mental health professionals who are trained as coaches can address gaps in access to care for youth. We demonstrate one strategy for strengthening and leveraging clinicians’ knowledge of CBT to support the school-based implementation of CBT.
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Affiliation(s)
- Allison E Meyer
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
| | | | - Kristen Miner
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Emily L Bilek
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jennifer Vichich
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Shawna N Smith
- Department of Health Management & Policy, School of Public Health, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
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Schmied EA, Glassman LH, Carinio SR, Dell'Acqua RG, Bryan CJ, Thomsen CJ. Suicide-Specific Training Experiences and Needs Among Military Mental Health Providers. Arch Suicide Res 2022:1-15. [PMID: 35510759 DOI: 10.1080/13811118.2022.2067510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Military suicide rates have risen over the past two decades, with a notable spike in recent years. To address this issue, military mental health providers must be equipped with the skills required to provide timely and effective care; yet little is known about the suicide-specific training experiences or needs of these professionals. METHODS Thirty-five mental health care providers who treat active duty personnel at military treatment facilities participated in this mixed-methods study. All participants completed a survey assessing training and clinical experiences, comfort and proficiency in working with patients at risk for suicide, and perceived barriers to obtaining suicide-specific training. A sub-set of participants (n = 8) completed a telephone interview to further describe previous experiences and perceived challenges to obtaining training. RESULTS The majority of participants (79.4%) had 6+ years of clinical experience, had a patient who had attempted suicide (85.3%), and completed at least one suicide-related training since finishing their education (82.4%). Survey results showed the leading barrier to enrolling in suicide-specific trainings was perceived lack of training opportunities (40.7% reported it was a barrier "quite often" or more), followed by lack of time (25%). Interview results revealed lack of time, location and logistical issues, and low perceived need for additional training among providers could impede enrollment. CONCLUSIONS Study results identified several modifiable barriers to receiving suicide-specific continuing education among military mental health providers. Future efforts should develop accessible training programs that can be easily integrated into routine clinical operations to mount the best defense against suicide. HIGHLIGHTSMilitary mental health providers report significant experience and relatively high degrees of comfort and proficiency working with patients at high risk for suicide.Most providers reported receiving training in suicide assessment and screening; few reported prior training in management of suicidality.Study results identified several modifiable barriers to receiving suicide-prevention continuing education among military mental health care providers; future efforts should seek to develop accessible training programs that can be easily integrated into routine clinical operations to mount the best defense against suicide.
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Frank HE, Milgram L, Freeman JB, Benito KG. Expanding the reach of evidence-based mental health interventions to private practice: Qualitative assessment using a policy ecology framework. FRONTIERS IN HEALTH SERVICES 2022; 2:892294. [PMID: 36925863 PMCID: PMC10012822 DOI: 10.3389/frhs.2022.892294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Abstract
Background Evidence-based interventions (EBIs) for mental health disorders are underutilized in routine clinical practice. Exposure therapy for anxiety disorders is one particularly difficult-to-implement EBI that has robust empirical support. Previous research has examined EBI implementation determinants in publicly funded mental health settings, but few studies have examined EBI implementation determinants in private practice settings. Private practice clinicians likely face unique barriers to implementation, including setting-specific contextual barriers to EBI use. The policy ecology framework considers broad systemic determinants, including organizational, regulatory, social, and political contexts, which are likely relevant to EBI implementation in private practice settings but have not been examined in prior research. Methods Qualitative interviews were conducted to assess private practice clinicians' perceptions of EBI implementation determinants using the policy ecology framework. Clinicians were asked about implementing mental health EBIs broadly and exposure therapy specifically. Mixed methods analyses compared responses from clinicians working in solo vs. group private practice and clinicians who reported high vs. low organizational support for exposure therapy. Results Responses highlight several barriers and facilitators to EBI implementation in private practice. Examples include determinants related to organizational support (e.g., colleagues using EBIs), payer restrictions (e.g., lack of reimbursement for longer sessions), fiscal incentives (e.g., payment for attending training), and consumer demand for EBIs. There were notable differences in barriers faced by clinicians who work in group private practices compared to those working in solo practices. Solo private practice clinicians described ways in which their practice setting limits their degree of colleague support (e.g., for consultation or exposure therapy planning), while also allowing for flexibility (e.g., in their schedules and practice location) that may not be available to clinicians in group practice. Conclusions Using the policy ecology framework provides a broad understanding of contextual factors that impact private practice clinicians' use of EBIs, including exposure therapy. Findings point to potential implementation strategies that may address barriers that are unique to clinicians working in private practice.
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Affiliation(s)
- Hannah E Frank
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Bradley Hospital, East Providence, RI, United States
| | - Lauren Milgram
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Bradley Hospital, East Providence, RI, United States
| | - Jennifer B Freeman
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Bradley Hospital, East Providence, RI, United States
| | - Kristen G Benito
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Bradley Hospital, East Providence, RI, United States
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Sawrikar V, Plant AL, Andrade B, Woolgar M, Scott S, Gardner E, Dean C, Tully LA, Hawes DJ, Dadds MR. Global Workforce Development in Father Engagement Competencies for Family-Based Interventions Using an Online Training Program: A Mixed-Method Feasibility Study. Child Psychiatry Hum Dev 2021; 54:758-769. [PMID: 34800248 PMCID: PMC10140122 DOI: 10.1007/s10578-021-01282-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
Global access to practitioner training in the clinical engagement of fathers in family-based interventions is limited. The current study evaluated the feasibility of training practitioners in Canada and UK using online training developed in Australia by examining improvements in practitioner confidence and competence in father engagement, training satisfaction, qualitative feedback, and benchmarking results to those from an Australian sample. Practitioners were recruited to participate in a 2-h online training program through health services and charity organisations. The online program required practitioners to watch a video and complete self-reflection exercises in a digital workbook. Pre- and post-training measures were collected immediately before and after the online training program. The results indicated significantly large improvements in self-reported confidence and competence in engaging fathers following training, with levels of improvement similar to those found in Australia. Training satisfaction was high and qualitative feedback suggested providing local resources and increasing representation of social diversity could improve training relevance in local contexts. The findings suggest online training in father engagement can contribute to global workforce development in improving practitioners' skills in engaging fathers in family-based interventions.
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Affiliation(s)
- Vilas Sawrikar
- Department of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK.
| | - Alexandra L Plant
- Department of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Brendan Andrade
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Matt Woolgar
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK
| | - Stephen Scott
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK
| | | | | | - Lucy A Tully
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - David J Hawes
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Mark R Dadds
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
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Green A, MacLean R, Charles K. Female Narcissism: Assessment, Aetiology, and Behavioural Manifestations. Psychol Rep 2021; 125:2833-2864. [PMID: 34154472 PMCID: PMC9578082 DOI: 10.1177/00332941211027322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Despite putative gender differences in the expression of narcissism, prominent theories have virtually dismissed the role of females in the development and manifestation of narcissism. The contention that narcissism is a pathology of the self that may partly differ in males and females is further evident in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 reports that up to 75% of those diagnosed with Narcissistic Personality Disorder (NPD) are men. Such figures suggest that the representation of narcissism as codified in the DSM-5 may only be marginally applicable to females, given its prominent focus and nature on capturing grandiose themes which closely resemble commonly masculine norms. The overemphasis on grandiose features extends to the empirical literature which defines narcissism as a normative personality trait and is widely assessed using the Narcissistic Personality Inventory (NPI), on which males obtain significantly higher scores than females. As this review will demonstrate, one limitation frequently occurring in the literature is the attempt to comprehend narcissistic manifestations in females through the lens of what has commonly been defined as narcissism (DSM/NPI). In this review, the literature concerning the diagnostic assessment and conceptualisation of narcissistic personality disorder, aetiological factors, aggression, and partner violence perpetration will be discussed in relation to the importance of gender. This is followed by a review of existing gaps in theory and research, and suggestions for fruitful directions that can aid a richer and more meaningful literature on narcissism inclusive of gender issues.
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Affiliation(s)
- Ava Green
- City University of London, Department of Psychology, London, UK
| | - Rory MacLean
- Edinburgh Napier University, School of Applied Sciences, Edinburgh, UK
| | - Kathy Charles
- Nottingham Trent University, Centre for Academic Development and Quality, Nottingham, UK
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13
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Ametaj AA, Wilner Tirpak J, Cassiello-Robbins C, Snow R, Rassaby MM, Beer K, Sauer-Zavala S. A Preliminary Investigation of Provider Attitudes Toward a Transdiagnostic Treatment: Outcomes from Training Workshops with the Unified Protocol. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:668-682. [PMID: 33538945 DOI: 10.1007/s10488-020-01101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
Evidence-based psychological treatments (EBPTs) for common mental health conditions are efficacious but remain underutilized in clinical service settings. Novel transdiagnostic and modular approaches that treat several disorders simultaneously promise to address common barriers to the dissemination and implementation of traditional EBPTs. Despite the promise that transdiagnostic treatments hold, the claims that these interventions can be more easily disseminated and implemented have not been widely tested. The present study examined whether a transdiagnostic treatment, the Unified Protocol (UP), addresses some barriers to dissemination and implementation for clinicians. Exploratory aims of the current study were to examine the effects of a UP introductory training workshop on clinician attitudes and behaviors by: (1) evaluating UP knowledge and treatment delivery, (2) determining relationships between clinician characteristics and their knowledge acquisition, satisfaction with UP, and UP penetration, and (3) exploring clinicians' perceptions of the UP's characteristics utilizing mixed methods. Workshop participants showed a good understanding of UP treatment concepts following training, and over a third of survey respondents reported use of the intervention 6-months after training. Positive attitudes toward EBPTs and fewer years of clinical practice were associated with greater satisfaction with the UP. Clinicians held positive views of the UP's flexibility and relative advantage over standard EBPTs but held negative views toward the manual's design and packaging. Overall, our findings suggest that clinicians may view transdiagnostic treatments such as the UP favorably and may consider them appealing over standard EBPTs. However, barriers associated with traditional EBPTs may extend to transdiagnostic treatments like the UP.
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Affiliation(s)
- Amantia A Ametaj
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA. .,Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02215, USA.
| | | | - Clair Cassiello-Robbins
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Rachel Snow
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Madeleine M Rassaby
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Kelsey Beer
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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14
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Boyd MR, Park AL, Becker KD, Chorpita BF. The relation between training asymmetry and supervisory working alliance: implications for the role of supervisors in implementation. CLINICAL SUPERVISOR 2021. [DOI: 10.1080/07325223.2020.1871460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Meredith R. Boyd
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Alayna L. Park
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Kimberly D. Becker
- Department of Psychology, University of South Carolina, Columbia, Carolina, USA
| | - Bruce F. Chorpita
- Department of Psychology, University of California, Los Angeles, California, USA
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15
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Hamill NR, Wiener KKK. Attitudes of Psychologists in Australia towards evidence‐based practice in psychology. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wakai S, Schilling EA, Aseltine RH, Blair EW, Bourbeau J, Duarte A, Durst LS, Graham P, Hubbard N, Hughey K, Weidner D, Welsh A. Suicide prevention skills, confidence and training: Results from the Zero Suicide Workforce Survey of behavioral health care professionals. SAGE Open Med 2020; 8:2050312120933152. [PMID: 32595971 PMCID: PMC7298428 DOI: 10.1177/2050312120933152] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 05/11/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction: In behavioral health care settings, a workforce well trained in suicide
prevention is critically important for behavioral health care professionals
across different disciplines and service sectors who are likely to have
considerable exposure to patients at risk for suicidal behavior. This study
examined the types of training behavioral health care professionals
received, their self-reported skills, comfort level and confidence related
to suicide prevention, the association of types and length of training with
skills, comfort level and confidence, and areas in which participants would
like more training. Methods: The Zero Suicide Workforce Survey was administered electronically to
behavioral health care professionals at six behavioral health treatment
centers with both inpatient and ambulatory programs in Connecticut, USA.
Item numbers and percentages were calculated for 847 respondents with
behavioral health care roles. The chi-square tests were performed to
determine the statistical significance of group differences. Non-parametric
sign tests were performed to determine the statistical significance of the
collective differences in direction among items between groups. Results: Suicide prevention training is associated with increased levels of behavioral
health care professionals’ skills and confidence, but one-third of
behavioral health care professionals in the sample received no formal
training in suicide prevention/intervention. Even brief training appears to
have a positive impact on behavioral health care professionals’ assessment
of their skills and confidence. Prominent topics for additional training
include suicide-specific treatment approaches, suicide prevention and
awareness, and identification of risk factors and warning signs. Conclusion: Although behavioral health care professionals may often encounter patients at
risk for suicide, many have not obtained any relevant training. The findings
highlight the need to strengthen suicide identification, assessment and
treatment within behavioral health care treatment settings as part of an
effort to prevent suicide.
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Affiliation(s)
- Sara Wakai
- Department of Medicine, UConn Health, Farmington, CT, USA
| | | | | | | | | | - Andrea Duarte
- Connecticut Department of Mental Health and Addiction Services, Hartford, CT, USA
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17
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Applying NUDGE to Inform Design of EBP Implementation Strategies in Community Mental Health Settings. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:131-142. [PMID: 32430590 DOI: 10.1007/s10488-020-01052-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We demonstrate the application of NUDGE (Narrow, Understand, Discover, Generate, Evaluate), a behavioral economics approach to systematically identifying behavioral barriers that impede behavior enactment, to the challenge of evidence-based practice (EBP) use in community behavioral health. Drawing on 65 clinician responses to a system-wide crowdsourcing challenge about EBP underutilization, we applied NUDGE to discover, synthesize and validate specific behavioral barriers to EBP utilization that directly inform the design of tailored implementation strategies. To our knowledge, this is the first study to apply behavioral economic insights to clinician-proposed solutions to implementation challenges in order to design implementation strategies. The study demonstrates the successful application of NUDGE to implementation strategy design and provides novel targets for intervention.
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18
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Understanding Australian Community ABI Therapists’ Preferences for Training in and Implementing Behaviour Interventions: A Focus on Positive Behaviour Support. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.32] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Individuals with acquired brain injury (ABI) may experience persistent and distressing challenging behaviours (CB), and therefore, effective delivery of behaviour interventions is crucial. This study aimed to investigate community ABI therapists’ experiences of using, training in and implementing behaviour interventions with a focus on Positive Behaviour Support (PBS).Methods:A sample of Australian community ABI therapists (n = 136) completed an online survey about their experiences with behaviour interventions, including PBS. Data from open-ended questions were analysed using content analysis. Frequency and descriptive statistics were computed, and a multiple regression was performed to determine factors predicting readiness to learn and implement new behaviour interventions. Rank-based non-parametric tests were conducted to investigate the influence of clinical role on experiences with behaviour interventions and training preferences.Results:Consistent with PBS, participants indicated that the following were important in addressing CB: teamwork and collaboration, person-centred practice, working with antecedents, environmental modification, improving quality of life and skill-building. Despite a high level of desire and readiness, 80% of participants reported facing barriers to learning and implementing new behaviour interventions (e.g., lack of time). Participants’ confidence in using behaviour interventions (β = 0.31; p = 0.002) and the number of barriers faced (β = −0.30; p = 0.002) predicted their readiness to learn and implement new behaviour interventions. Confidence, duration of past training in behaviour interventions and preferred duration of future training did not differ based on clinical role.Conclusion:Implications for the development of training in behaviour interventions such as PBS and implementation into community practice are discussed.
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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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20
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Iliakis EA, Sonley AKI, Ilagan GS, Choi-Kain LW. Treatment of Borderline Personality Disorder: Is Supply Adequate to Meet Public Health Needs? Psychiatr Serv 2019; 70:772-781. [PMID: 31138059 DOI: 10.1176/appi.ps.201900073] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to assess the supply of and demand for treatment of borderline personality disorder (BPD) to inform current standards of care and training in the context of available resources worldwide. METHODS The total supply of mental health professionals and mental health professionals certified in specialist evidence-based treatments for BPD was estimated for 22 countries by using data from publicly available sources and training programs. BPD prevalence and treatment-seeking rates were drawn from large-scale national epidemiological studies. Ratios of treatment-seeking patients to available providers were computed to assess whether current systems are able to meet demand. Training and certification requirements were summarized. RESULTS The ratio of treatment-seeking patients with BPD to mental health professionals (irrespective of professionals' interest or training in treating BPD) ranged from approximately 4:1 in Australia, the Netherlands, and Norway to 192:1 in Singapore. The ratio of treatment-seeking patients to clinicians certified in providing evidence-based care ranged from 49:1 in Norway to 148,215:1 in Mexico. Certification requirements differed by treatment and by country. CONCLUSIONS Shortages of both providers available to treat BPD and providers certified in specialist treatments of BPD exist in most of the 22 countries studied. In well-resourced countries, training clinicians to provide generalist or abbreviated treatments for BPD, in addition to specialist treatments, could help address the current implementation gap. More resource-efficient alternatives must be considered in countries with insufficient staff to implement even generalist treatments. Consideration of realistic allocation of care may shape future guidelines and standards of BPD treatments, beyond intensive evidence-based psychotherapies.
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Affiliation(s)
- Evan A Iliakis
- Adult Borderline Center and Training Institute, McLean Hospital, Belmont, Massachusetts (Iliakis, Ilagan, Choi-Kain); Center for Addiction and Mental Health, University of Toronto, Toronto (Sonley); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain)
| | - Anne K I Sonley
- Adult Borderline Center and Training Institute, McLean Hospital, Belmont, Massachusetts (Iliakis, Ilagan, Choi-Kain); Center for Addiction and Mental Health, University of Toronto, Toronto (Sonley); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain)
| | - Gabrielle S Ilagan
- Adult Borderline Center and Training Institute, McLean Hospital, Belmont, Massachusetts (Iliakis, Ilagan, Choi-Kain); Center for Addiction and Mental Health, University of Toronto, Toronto (Sonley); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain)
| | - Lois W Choi-Kain
- Adult Borderline Center and Training Institute, McLean Hospital, Belmont, Massachusetts (Iliakis, Ilagan, Choi-Kain); Center for Addiction and Mental Health, University of Toronto, Toronto (Sonley); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain)
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21
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Skriner LC, Wolk CB, Stewart RE, Adams DR, Rubin RM, Evans AC, Beidas RS. Therapist and Organizational Factors Associated with Participation in Evidence-Based Practice Initiatives in a Large Urban Publicly-Funded Mental Health System. J Behav Health Serv Res 2019; 45:174-186. [PMID: 28439788 DOI: 10.1007/s11414-017-9552-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Laura C Skriner
- Center for Mental Health Policy and Services Research, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA
| | - Courtney Benjamin Wolk
- Center for Mental Health Policy and Services Research, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA
| | - Rebecca E Stewart
- Center for Mental Health Policy and Services Research, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA
| | - Danielle R Adams
- Center for Mental Health Policy and Services Research, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA
| | - Ronnie M Rubin
- Department of Behavioral Health and Intellectual disAbility Services, 1101 Market Street, Floor 7, Philadelphia, PA, 19107, USA
| | - Arthur C Evans
- Center for Mental Health Policy and Services Research, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA
- Department of Behavioral Health and Intellectual disAbility Services, 1101 Market Street, Floor 7, Philadelphia, PA, 19107, USA
| | - Rinad S Beidas
- Center for Mental Health Policy and Services Research, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA.
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22
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Bullis JR, Boettcher H, Sauer‐Zavala S, Farchione TJ, Barlow DH. What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2019. [DOI: 10.1111/cpsp.12278] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Jacqueline R. Bullis
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
- Division of Depression and Anxiety Disorders Harvard Medical School McLean Hospital Belmont Massachusetts
| | - Hannah Boettcher
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
| | | | - Todd J. Farchione
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
| | - David H. Barlow
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
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23
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Navarro-Haro MV, Harned MS, Korslund KE, DuBose A, Chen T, Ivanoff A, Linehan MM. Predictors of Adoption and Reach Following Dialectical Behavior Therapy Intensive Training™. Community Ment Health J 2019; 55:100-111. [PMID: 29508180 DOI: 10.1007/s10597-018-0254-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/27/2018] [Indexed: 10/17/2022]
Abstract
Dialectical behavior therapy (DBT) is an evidence-based treatment for borderline personality disorder. The DBT Intensive Training™ is widely used to train community clinicians to deliver DBT, but little is known about its effectiveness. This study prospectively evaluated predictors of adoption and reach of DBT among 52 community teams (212 clinicians) after DBT Intensive Training™. Pre-post training questionnaires were completed by trainees and a follow-up survey by team leaders approximately 8 months later. Overall, 75% of teams adopted all DBT modes and delivered DBT to an average of 118 clients. Lower training and program needs, fewer bachelor's-level clinicians, and greater prior DBT experience predicted adoption of more DBT modes. More prior DBT experience, smaller team size, more negative team functioning, and staff with lower job satisfaction, growth, efficacy, and influence predicted greater DBT reach. DBT Intensive Training™ appears effective in promoting DBT adoption and reach in routine clinical practice settings.
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Affiliation(s)
- Maria V Navarro-Haro
- Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Seattle, WA, USA. .,Hospital Universitario General de Cataluña, Instituto Trastorno Límite, Sant Cugat, Barcelona, Spain.
| | - Melanie S Harned
- Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Seattle, WA, USA.,Behavioral Tech, LLC, Seattle, WA, USA
| | - Kathryn E Korslund
- Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Tianying Chen
- Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Seattle, WA, USA.,University of Michigan, Ann Arbor, MI, USA
| | | | - Marsha M Linehan
- Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Seattle, WA, USA
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24
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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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Stewart RE, Chambless DL, Stirman SW. Decision making and the use of evidence based practice: Is the three-legged stool balanced? ACTA ACUST UNITED AC 2018; 3:56-67. [PMID: 32219174 DOI: 10.1037/pri0000063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This article presents the results of a qualitative analysis of interviews with 25 psychologists in independent practice, with a focus on decision making with a selected patient. We endeavored to examine how clinical decision making intersected with the principles of evidence based practice (EBP) as laid out by Spring (2007). Clinicians reported that diagnostic impressions were generally formulated through unstructured assessment rather than validated instruments, and that treatment selection was based on therapists' perceptions of a treatment's match with client characteristics. Therapists viewed CBTs as appropriate for addressing symptoms but believed they needed to depart from CBT strategies to address underlying issues. Nonetheless, they often defined successes and failures in treatment in terms of symptoms. Overall, clinicians rarely mentioned utilization of research evidence for assessment or treatment selection and practice. Results are discussed within the framework of EBP.
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26
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Crome E, Shaw J, Baillie A. Costs and returns on training investment for empirically supported psychological interventions. AUST HEALTH REV 2018; 41:82-88. [PMID: 27007500 DOI: 10.1071/ah15129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 02/01/2016] [Indexed: 11/23/2022]
Abstract
Objective Financial costs are a significant barrier to the uptake of empirically supported psychological interventions in clinical settings. Training may be among the largest of these costs; however, the potential magnitude of these costs is unclear. The aim of the present study was to develop a hypothetical model of potential training costs associated with adopting a novel therapy using systematic review of anticipated training durations and publicly available data on workshop costs, training materials and income. Methods Direct and indirect costs were estimated for reference categories being cognitive behavioural therapy for social anxiety disorder delivered by registered psychologists. These were based on averages of 39 workshops and eight treatment manuals available in Australia identified through online searches. Results This model demonstrated that upper cost ranges for training can exceed A$55000, and even didactic training (reading manuals, attending workshops) may cost up to A$9000. Indirect costs of forfeited income account for a substantial proportion of these costs. Conclusions This hypothetical model highlights why training costs should be considered in decisions about disseminating and implementing novel empirically supported psychological interventions, particularly within private workforces. In addition, the direct return on training investment for practitioners in private practice is unclear, and may vary based on caseloads and current treatment modalities. Initiatives to track competence, support training and identify novel training solutions may be required to ensure the sustainability of high-quality mental healthcare. What is known about the topic? Financial costs are one of the leading factors determining whether empirically supported mental health treatments are adopted or sustained. Training costs may be one of the largest costs of disseminating and implementing novel psychological therapies within existing workforces, including both direct (e.g. workshop fees) and indirect (e.g. lost income) costs. However, little is understood about the potential magnitude of these costs. What does this paper add? This paper presents a hypothetical modelling of potential costs associated with adopting a novel therapy, with reference categories for an empirically supported treatment (cognitive behaviour therapy) for one mental disorder (social anxiety disorder) for one mental health profession (psychologist). This model was developed and populated using systematic review of anticipated training durations and publicly available data on workshop costs, training materials and income. What are the implications for practitioners? With potential costs for adopting one novel psychological intervention exceeding A$55000, we highlight why training costs and pathways should be a focal point for ensuring the sustainable provision of high-quality mental healthcare in Australia.
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Affiliation(s)
- Erica Crome
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, Centre for Emotional Health, Psychology Department, Macquarie University, NSW 2109, Australia. Email
| | - Joanne Shaw
- Psycho-oncology Co-operative Research Group, School of Psychology, The University of Sydney, NSW 2006, Australia. Email
| | - Andrew Baillie
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, Centre for Emotional Health, Psychology Department, Macquarie University, NSW 2109, Australia. Email
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Bui E, Chad-Friedman E, Wieman S, Grasfield RH, Rolfe A, Dong M, Park ER, Denninger JW. Patient and Provider Perspectives on a Mind–Body Program for Grieving Older Adults. Am J Hosp Palliat Care 2017; 35:858-865. [DOI: 10.1177/1049909117743956] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Eric Bui
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - Elyse R. Park
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - John W. Denninger
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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28
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Years of Clinical Experience and Therapist Professional Development: A Literature Review. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2017. [DOI: 10.1007/s10879-017-9373-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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29
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Presidential Address: Embracing the Repulsive: The Case for Disgust as a Functionally Central Emotional State in the Theory, Practice, and Dissemination of Cognitive-Behavior Therapy. Behav Ther 2017; 48:731-738. [PMID: 29029671 DOI: 10.1016/j.beth.2017.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 11/20/2022]
Abstract
Disgust is a primary emotion, but it is also understudied in general, and in psychopathology in particular. Disgust plays a potential role in the reluctance of many non-scientifically minded practitioners from adopting evidence-based methods of treatment. This article summarizes findings from psychopathology research and treatment, and highlights basic science that potentially accounts for the hesitancy for some therapists to adopt evidence-based methods. Several recommendations are provided for future research in disgust related to both psychopathology and dissemination research.
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30
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Anestis MD, Law KC, Jin H, Houtsma C, Khazem LR, Assavedo BL. Treating the Capability for Suicide: A Vital and Understudied Frontier in Suicide Prevention. Suicide Life Threat Behav 2017; 47:523-537. [PMID: 27862187 DOI: 10.1111/sltb.12311] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 06/28/2016] [Indexed: 11/29/2022]
Abstract
Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence-based treatments, and yet the national suicide rate has continued to climb. We propose that this disconnect is heavily influenced by an unmet need to consider population-level interventions aimed at reducing the capability for suicide. Drawing on lessons learned from other public health phenomena that have seen drastic declines in frequency in recent decades (HIV, lung cancer, motor vehicle accidents), we propose that current suicidality treatment efforts trail current suicidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt. We summarize extant evidence for specific capability-centered approaches (e.g., means safety) and propose other options for improving our ability to address this largely overlooked variable. We also note that population-level approaches in this regard would represent an important opportunity to decrease risk in individuals who either lack access to evidence-based care or underreport suicidal ideation, as a reduced capability for suicide would theoretically diminish the potency of suicidal desire and, in this sense, lower the odds of a transition from ideation to attempt.
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Affiliation(s)
| | - Keyne C Law
- University of Southern Mississippi, Hattiesburg, MS, USA
| | - Hyejin Jin
- University of Southern Mississippi, Hattiesburg, MS, USA
| | - Claire Houtsma
- University of Southern Mississippi, Hattiesburg, MS, USA
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Richter J, Pittig A, Hollandt M, Lueken U. Bridging the Gaps Between Basic Science and Cognitive-Behavioral Treatments for Anxiety Disorders in Routine Care. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2017. [DOI: 10.1027/2151-2604/a000309] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. As a core component of cognitive-behavioral therapies (CBT), behavioral exposure is an effective treatment for anxiety disorders. Still, recent treatment studies demonstrate relatively high rates of treatment dropout, nonresponse, and relapse, indicating a substantial need for optimizing and personalizing existing treatment procedures. In the present article, we aim to address current challenges and future demands for translational research in CBT for the anxiety disorders, including (a) a better understanding of those mechanisms conferring behavioral change, (b) identifying important sources of individual variation that may act as moderators of treatment response, and (c) targeting practical barriers for dissemination of exposure therapy to routine care. Based on a recursive process model of psychotherapy research we will describe distinct steps to systematically translate basic and clinical research “from bench to bedside” to routine care, but also vice versa. Some of these aspects may stimulate the future roadmap for evidence-based psychotherapy research in order to better target the treatment of anxiety disorders as one core health challenge of our time.
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Affiliation(s)
- Jan Richter
- Department of Physiological and Clinical Psychology/Psychotherapy, University of Greifswald, Germany
| | - Andre Pittig
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Germany
| | - Maike Hollandt
- Department of Physiological and Clinical Psychology/Psychotherapy, University of Greifswald, Germany
| | - Ulrike Lueken
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany
- Department of Psychology, Humboldt University of Berlin, Germany
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Kobak KA, Wolitzky-Taylor K, Craske MG, Rose RD. Therapist Training on Cognitive Behavior Therapy for Anxiety Disorders Using Internet-Based Technologies. COGNITIVE THERAPY AND RESEARCH 2017; 41:252-265. [PMID: 28435174 PMCID: PMC5396958 DOI: 10.1007/s10608-016-9819-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study investigated a technology-enhanced training protocol to facilitate dissemination of therapist training on cognitive behavior therapy (CBT) for anxiety disorders. Seventy community clinicians received an online tutorial followed by live remote observation of clinical skills via videoconference. Impact of training on patient outcomes was also assessed. Training resulted in a significant increase in both trainee knowledge of CBT concepts and techniques and therapist competence in applying these skills. Patients treated by trainees following training had significant reductions in anxiety and depression. Ratings of user satisfaction were high. Results provide support for the use of these technologies for therapist training in CBT.
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Affiliation(s)
| | - Kate Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | | | - Raphael D. Rose
- Department of Psychology, University of California, Los Angeles
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Evidence-based training in the era of evidence-based practice: Challenges and opportunities for training of PTSD providers. Behav Res Ther 2017; 88:37-48. [DOI: 10.1016/j.brat.2016.07.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/24/2016] [Accepted: 07/26/2016] [Indexed: 11/22/2022]
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Olin SS, Nadeem E, Gleacher A, Weaver J, Weiss D, Hoagwood KE, Horwitz SM. What Predicts Clinician Dropout from State-Sponsored Managing and Adapting Practice Training. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 43:945-956. [PMID: 26699136 PMCID: PMC5545802 DOI: 10.1007/s10488-015-0709-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Dropouts from system-wide evidence-based practice trainings are high; yet there are few studies on what predicts dropouts. This study examined multilevel predictors of clinician dropout from a statewide training on the Managing and Adapting Practice program. Extra-organizational structural variables, intra-organizational variables and clinician variables were examined. Using multivariable logistic regression analysis, state administrative data and prospectively collected clinician participation data were used to predict dropout. Two characteristics were predictive: younger clinicians and those practicing in upstate-rural areas compared to downstate-urban areas were less likely to drop out from training. Implications for research and policy are described.
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Affiliation(s)
- S Serene Olin
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, One Park Avenue, 7th Floor, New York, NY, 10016, USA.
| | - Erum Nadeem
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Alissa Gleacher
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - James Weaver
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Dara Weiss
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Kimberly E Hoagwood
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, One Park Avenue, 7th Floor, New York, NY, 10016, USA
- New York State Office of Mental Health, Albany, NY, USA
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, One Park Avenue, 7th Floor, New York, NY, 10016, USA
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Gryglewicz K, Chen JI, Romero GD, Karver MS, Witmeier M. Online Suicide Risk Assessment and Management Training. CRISIS 2016; 38:186-194. [PMID: 27659517 DOI: 10.1027/0227-5910/a000421] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many mental health professionals (MHPs) encounter youth at risk for suicide but lack knowledge and confidence to assist these individuals. Unfortunately, training for MHPs on suicide risk assessment and management is often not adequately accessible. AIMS The aim of this study was to evaluate whether MHPs' knowledge, attitudes, perceived social norms, and perceived behavioral control in working with at-risk suicidal youth improve following an online training (QPRT: Question, Persuade, Refer, Treat). METHOD QPRT was provided to 225 MHPs from three large urban areas in the United States. Suicide prevention literacy, attitudes, perceived social norms, and perceived behavioral control in assessing and managing suicide risk were assessed before and after training. Data were also collected on training engagement and completion. RESULTS Suicide prevention literacy in most competency domains and perceived behavioral control increased significantly after participation in QPRT. Suicide prevention attitudes and some knowledge domains did not significantly improve. MHPs reported high satisfaction with the training. CONCLUSION The current study provides initial support for offering MHPs online suicide risk assessment and management training. Online training programs may be an engaging and feasible means for providing advanced suicide prevention skills to MHPs who may have numerous barriers to accessing face-to-face training.
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Affiliation(s)
- Kim Gryglewicz
- 1 School of Social Work, University of Central Florida, Orlando, FL, USA
| | - Jason I Chen
- 2 Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Gabriela D Romero
- 2 Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Marc S Karver
- 2 Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Melissa Witmeier
- 3 Florida Council for Community Mental Health, Tallahassee, FL, USA
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Becker EM, Jensen-Doss A. Therapist attitudes towards computer-based trainings. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 41:845-54. [PMID: 24150441 DOI: 10.1007/s10488-013-0522-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Computer-based trainings are a promising avenue for increasing access to training in evidence-based practices. However, little is known about whether therapists are willing to use them. Results from a national survey of practicing therapists (N = 1,067) indicated that 26 % of therapists reported previously using a computer-based training and overall attitudes (as measured by the Computer-Based Training Attitudes Scale) were positive. Higher therapist computer fluency and greater openness to new treatments predicted positive attitudes. Therapists with more positive attitudes were more likely to have previously used a computer-based training. Implications are discussed.
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Affiliation(s)
- Emily M Becker
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, 33124-0751, USA,
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Robinson SM, Adinoff B. The Classification of Substance Use Disorders: Historical, Contextual, and Conceptual Considerations. Behav Sci (Basel) 2016; 6:bs6030018. [PMID: 27548233 PMCID: PMC5039518 DOI: 10.3390/bs6030018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/12/2016] [Accepted: 08/01/2016] [Indexed: 11/25/2022] Open
Abstract
This article provides an overview of the history of substance use and misuse and chronicles the long shared history humans have had with psychoactive substances, including alcohol. The practical and personal functions of substances and the prevailing views of society towards substance users are described for selected historical periods and within certain cultural contexts. This article portrays how the changing historical and cultural milieu influences the prevailing medical, moral, and legal conceptualizations of substance use as reflected both in popular opinion and the consensus of the scientific community and represented by the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). Finally, this article discusses the efforts to classify substance use disorders (SUDs) and associated psychopathology in the APA compendium. Controversies both lingering and resolved in the field are discussed, and implications for the future of SUD diagnoses are identified.
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Affiliation(s)
- Sean M Robinson
- Veterans Affairs North Texas Health Care System, 4500 S. Lancaster Road, Dallas, TX 75216, USA.
| | - Bryon Adinoff
- Veterans Affairs North Texas Health Care System, 4500 S. Lancaster Road, Dallas, TX 75216, USA.
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA.
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Persons JB, Koerner K, Eidelman P, Thomas C, Liu H. Increasing psychotherapists' adoption and implementation of the evidence-based practice of progress monitoring. Behav Res Ther 2016; 76:24-31. [PMID: 26618237 PMCID: PMC4723103 DOI: 10.1016/j.brat.2015.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 09/22/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
Abstract
Evidence-based practices (EBPs) reach consumers slowly because practitioners are slow to adopt and implement them. We hypothesized that giving psychotherapists a tool + training intervention that was designed to help the therapist integrate the EBP of progress monitoring into his or her usual way of working would be associated with adoption and sustained implementation of the particular progress monitoring tool we trained them to use (the Depression Anxiety Stress Scales on our Online Progress Tracking tool) and would generalize to all types of progress monitoring measures. To test these hypotheses, we developed an online progress monitoring tool and a course that trained psychotherapists to use it, and we assessed progress monitoring behavior in 26 psychotherapists before, during, immediately after, and 12 months after they received the tool and training. Immediately after receiving the tool + training intervention, participants showed statistically significant increases in use of the online tool and of all types of progress monitoring measures. Twelve months later, participants showed sustained use of any type of progress monitoring measure but not the online tool.
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Affiliation(s)
| | | | | | - Cannon Thomas
- San Francisco Group for Evidence-Based Psychotherapy, USA
| | - Howard Liu
- San Francisco Bay Area Center for Cognitive Therapy, USA
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Lundgren J, Andersson G, Dahlström Ö, Jaarsma T, Köhler AK, Johansson P. Internet-based cognitive behavior therapy for patients with heart failure and depressive symptoms: A proof of concept study. PATIENT EDUCATION AND COUNSELING 2015; 98:935-942. [PMID: 25990216 DOI: 10.1016/j.pec.2015.04.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/16/2015] [Accepted: 04/19/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The aim was (1) to describe the development of a guided internet-based CBT (ICBT) program adapted to patients with heart failure (HF) and (2) to evaluate the feasibility of the ICBT program in regard to depressive symptoms, the time used by health care providers to give feedback, and participants' perceptions of the ICBT program. METHOD A multi-professional team developed the program and seven HF patients with depressive symptoms were recruited to the study. The Patient Health Questionnaire-9 (PHQ-9) and the Montgomery Åsberg Depression Rating-Self-rating scale (MADRS-S) were used to measure depression, and patients were interviewed about their perceptions of the program. RESULTS Based on research in HF and CBT, a nine-week program was developed. The median depression score decreased from baseline to the end of the study (PHQ-9: 11-8.5; MADRS-S: 25.5-16.5) and none of the depression scores worsened. Feedback from health care providers required approximately 3h per patient. Facilitating perceptions (e.g. freedom of time) and demanding perceptions (e.g. part of the program demanded a lot of work) were described by the patients. CONCLUSION The program appears feasible and time-efficient. However, the program needs to be evaluated in a larger randomized study.
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Affiliation(s)
- Johan Lundgren
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
| | - Örjan Dahlström
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
| | - Anita Kärner Köhler
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
| | - Peter Johansson
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden; Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
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Khanna MS, Kendall PC. Bringing Technology to Training: Web-Based Therapist Training to Promote the Development of Competent Cognitive-Behavioral Therapists. COGNITIVE AND BEHAVIORAL PRACTICE 2015. [DOI: 10.1016/j.cbpra.2015.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lilienfeld SO, Ritschel LA, Lynn SJ, Cautin RL, Latzman RD. Why Ineffective Psychotherapies Appear to Work: A Taxonomy of Causes of Spurious Therapeutic Effectiveness. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2015; 9:355-87. [PMID: 26173271 DOI: 10.1177/1745691614535216] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The past 40 years have generated numerous insights regarding errors in human reasoning. Arguably, clinical practice is the domain of applied psychology in which acknowledging and mitigating these errors is most crucial. We address one such set of errors here, namely, the tendency of some psychologists and other mental health professionals to assume that they can rely on informal clinical observations to infer whether treatments are effective. We delineate four broad, underlying cognitive impediments to accurately evaluating improvement in psychotherapy-naive realism, confirmation bias, illusory causation, and the illusion of control. We then describe 26 causes of spurious therapeutic effectiveness (CSTEs), organized into a taxonomy of three overarching categories: (a) the perception of client change in its actual absence, (b) misinterpretations of actual client change stemming from extratherapeutic factors, and (c) misinterpretations of actual client change stemming from nonspecific treatment factors. These inferential errors can lead clinicians, clients, and researchers to misperceive useless or even harmful psychotherapies as effective. We (a) examine how methodological safeguards help to control for different CSTEs, (b) delineate fruitful directions for research on CSTEs, and (c) consider the implications of CSTEs for everyday clinical practice. An enhanced appreciation of the inferential problems posed by CSTEs may narrow the science-practice gap and foster a heightened appreciation of the need for the methodological safeguards afforded by evidence-based practice.
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Affiliation(s)
| | - Lorie A Ritschel
- Department of Psychiatry, University of North Carolina at Chapel Hill 3C Institute, Cary, NC
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Johnston JAY, O'Gara JSX, Koman SL, Baker CW, Anderson DA. A pilot study of maudsley family therapy with group dialectical behavior therapy skills training in an intensive outpatient program for adolescent eating disorders. J Clin Psychol 2015; 71:527-43. [PMID: 25867492 DOI: 10.1002/jclp.22176] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The goal of this study was to provide pilot clinical data on the effectiveness of an intensive outpatient treatment model for adolescent eating disorders that combines Maudsley-based family therapy and group dialectical behavior therapy skills training. METHOD Measures of physical and psychological status were gathered upon admission, discharge, and at 3 follow-up intervals. RESULTS Adolescents who completed the program gained a significant amount of weight and experienced a significant decrease in eating disorder psychopathology. At the 1-year follow-up, 64% of adolescents were weight restored and menstruating normally. Measures of eating disorder psychopathology continued to improve up to a year after treatment. CONCLUSIONS This pilot, multimodal program warrants further investigation and may be an effective intermediate level of care treatment option for adolescent eating disorders.
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Krejci J, Neugebauer Q. Motivational Interviewing in Groups: Group Process Considerations. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/1556035x.2015.999616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kobak KA, Greist R, Jacobi DM, Levy-Mack H, Greist JH. Computer-assisted cognitive behavior therapy for obsessive-compulsive disorder: a randomized trial on the impact of lay vs. professional coaching. Ann Gen Psychiatry 2015; 14:10. [PMID: 25722737 PMCID: PMC4341882 DOI: 10.1186/s12991-015-0048-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/04/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The purpose of the study was to examine the impact of computerized cognitive behavior therapy (CBT) self-help treatment for obsessive-compulsive disorder (OCD) (BT Steps) both alone and when supported by coaching from either a lay non-therapist coach or an experienced CBT therapist. METHODS Eighty-seven subjects with clinically significant OCD were recruited through newspaper ads and randomly assigned to receive 12 weeks of treatment with either BT Steps alone (n = 28), BT Steps with non-therapist coaching (n = 28), or BT Steps with CBT therapist coaching (n = 31). Subjects worked on BT Steps at their own pace. Subjects receiving BT Steps alone received a welcome call from the project manager. Subjects randomized to either of the coaching arms received regularly scheduled weekly phone calls for coaching, encouragement, and support. No formal therapy was provided by the coaches; thus, both lay and CBT coaches completed the same tasks. RESULTS All three treatment arms showed a significant reduction in Yale-Brown Obsessive Compulsive Scale (YBOCS) scores, with mean (SD) changes of 6.5 (5.7), 7.1 (6.1), and 6.5 (6.1) for the no coaching, lay coaching, and therapist coaching arms, respectively (all p's < .001). These represent effect sizes of 1.16, 1.41, and 1.12, respectively. No significant differences were found between treatment arms on YBOCS change scores, F(2) = 0.10, p = .904, or number of exposures sessions done (F(2) = 0.033, p = .967). When asked which method of therapy (computer vs. clinician) they preferred, 48% said computer, 33% said face-to-face therapy, and 19% had no preference. CONCLUSIONS Results support the use of online self-help for the treatment of moderate OCD. The addition of coaching by either a lay coach or a CBT therapist coach did not significantly improve outcomes.
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Affiliation(s)
- Kenneth A Kobak
- Center for Telepsychology, 7601 Ganser Way, Madison, WI 53719 USA
| | - Revere Greist
- Waypoint Health Innovations, 137 E. Wilson Street, Suite 812, Madison, WI 53703 USA
| | - David M Jacobi
- Rogers Memorial Hospital, 34700 Valley Rd, Oconomowoc, WI 53066 USA
| | | | - John H Greist
- Healthcare Technology Systems, 6515 Grand Teton Plaza, Suite 100, Madison, WI 53719 USA
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Kobak KA, Mundt JC, Kennard B. Integrating technology into cognitive behavior therapy for adolescent depression: a pilot study. Ann Gen Psychiatry 2015; 14:37. [PMID: 26535048 PMCID: PMC4630889 DOI: 10.1186/s12991-015-0077-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/20/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Rapid advances in information technology and telecommunications have resulted in a dramatic increase in the use of mobile devices and the internet to enhance and facilitate access to treatment. Cognitive behavior therapy (CBT) is an empirically based treatment that is well suited for enhancement by new technologies, particularly with youth. To facilitate the dissemination of this evidence-based treatment, we developed a technology-enhanced CBT intervention for the treatment of adolescent depression consisting of (1) online therapist training (2) in-session use of tablets for teaching clients CBT concepts and skills, and (3) text messaging for between session homework reminders and self-monitoring. METHODS Eighteen licensed clinicians (social workers n = 7, psychologists n = 9) were randomized to have their patients receive either the intervention (CBT) or treatment as usual (TAU). Each clinician treated four adolescents for 12 weeks. Clinicians in the CBT arm completed an online tutorial on CBT treatment of adolescent depression, then received an iPad with access to patient education materials for teaching CBT concepts to patients during sessions. Individualized text messages were integrated into treatment for homework reminders, support, and outcomes measurement. Outcome measures included a 49-item multiple choice test for tutorial effectiveness; the system usability scale (SUS) for user satisfaction; quick inventory of depressive symptomatology-adolescent version (QIDS-A-Pat); and clinician and patient ratings on the therapeutic alliance scale for adolescents (TASA). RESULTS A significant increase in knowledge of CBT concepts was found after completing the tutorial, t(8) = 7.02, p < 0.001. Clinician and patient ratings of user satisfaction were high for both the iPad teaching tools, and the text messaging. Ninety-five percent of teens said reviewing their text messages with their therapist was helpful, and all said they would use text messaging in treatment again. Ratings of the therapeutic alliance were higher in the CBT arm t(131) = 4.03, p = 0.001. A significant reduction in depression was found in both groups [t(34) = 8.453, p < 0.001 and t(29) = 6.67, p < 0.001 for CBT and TAU, respectively). Clinical ratings of improvement were greater on all outcome measures for the CBT arm; however, none reached statistical significance. Effect sizes (Cohen's d) ranged from small (QIDS-A) to large (TASA). CONCLUSIONS Results support the feasibility of this technology-enhanced CBT intervention as a means of improving CBT treatment of adolescent depression and may help address the critical shortage of therapists trained on empirically based treatments.
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Affiliation(s)
- Kenneth A Kobak
- Center for Telepsychology, 22 North Harwood, Madison, WI 53717 USA
| | - James C Mundt
- Center for Telepsychology, 22 North Harwood, Madison, WI 53717 USA
| | - Betsy Kennard
- UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390 USA
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McCracken LM, Marin FM. Current and future trends in psychology and chronic pain: time for a change? Pain Manag 2014; 4:113-21. [PMID: 24641435 DOI: 10.2217/pmt.13.76] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Psychological approaches to chronic pain have produced significant success and are widely accepted. Yet it can be difficult for those outside the field to understand the many different variables, processes and methods that are a part of these approaches. This is partly because these approaches are characterized by a wide variety of models, each with its own primary focus and background assumptions, and these can change over time. It may be difficult to create greater consistency and integration between currently disparate psychological approaches, but there may be advantages to doing so. This integration could be helped by an appropriately designed and appropriately organizing theoretical model. It is suggested that what is called the psychological flexibility model could provide such a point of integration.
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Affiliation(s)
- Lance M McCracken
- Health Psychology Section, Psychology Department, King's College London & INPUT Pain Management, Guy's & St Thomas' NHS Foundation Trust, London, UK.
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47
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Allen B, Crosby JW. Treatment beliefs and techniques of clinicians serving child maltreatment survivors. CHILD MALTREATMENT 2014; 19:49-60. [PMID: 24425800 DOI: 10.1177/1077559513518097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A significant focus in the child maltreatment field is greater dissemination and implementation of evidence-based treatments (EBTs). Research has attempted to identify attitudes toward EBTs and training experiences that predict clinicians' use of EBTs; however, these findings have yielded mixed results. This study reports on the results of a nationwide (United States) sample of 256 clinicians serving child maltreatment survivors, who completed questionnaires assessing beliefs about the clinical process, treatment technique selection, and attitudes toward EBTs. Psychometric data are presented on two new scales. The first scale examines clinicians' beliefs about two components of the clinical process: (1) the extent to which treatment should be structured/directed by the clinician and (2) children's verbal capacity to discuss traumatic events. The second scale assesses clinician-reported selection of various treatment techniques and contains four subscales: Cognitive-Behavioral, Play/Experiential, Psychodynamic, and Uncommon. Using these scales, a series of analyses were performed to determine which attitudes, beliefs, and training variables were associated with the selection of treatment techniques. After controlling for the impact of other variables, significant associations between the two clinical process beliefs and cognitive-behavioral and play/experiential techniques utilization were observed. Implications of these results for increasing implementation of EBTs with child maltreatment survivors are discussed.
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Affiliation(s)
- Brian Allen
- Center for Safe and Healthy Families, Primary Children's Medical Center, Salt Lake City, UT, USA
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48
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Chambless DL. Can we talk? Fostering interchange between scientists and practitioners. Behav Ther 2014; 45:47-50. [PMID: 24411113 DOI: 10.1016/j.beth.2013.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 08/15/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
Abstract
In response to three surveys of (mostly) cognitive-behavioral practitioners about barriers to treatment success with cognitive-behavioral therapy for patients with generalized anxiety disorder, panic disorder, and social phobia (McAleavey, Castonguay, & Goldfried, 2014-this issue; Szkodny, Newman, & Goldfried, 2014-this issue; Wolf & Goldfried, 2014-this issue), the author proposes several methods for tapping clinical expertise in the development and dissemination of psychological interventions. These include: following surveys with interviews of a subset of clinicians to obtain richer information, systematically incorporating answers to questions and problems trainees raise in supervision in efficacy or effectiveness trials, organizing clinical roundtables at meetings of the Association for Behavioral and Cognitive Therapies to discuss ways to address barriers identified in these surveys, and encouraging papers on these topics in Cognitive and Behavioral Practice. At the same time the author emphasizes that clinical observations are not facts and need to be verified in empirical research.
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Onken LS, Carroll KM, Shoham V, Cuthbert BN, Riddle M. Reenvisioning Clinical Science: Unifying the Discipline to Improve the Public Health. Clin Psychol Sci 2014; 2:22-34. [PMID: 25821658 PMCID: PMC4374633 DOI: 10.1177/2167702613497932] [Citation(s) in RCA: 452] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We present a vision of clinical science, based on a conceptual framework of intervention development endorsed by the Delaware Project. This framework is grounded in an updated stage model that incorporates basic science questions of mechanisms into every stage of clinical science research. The vision presented is intended to unify various aspects of clinical science toward the common goal of developing maximally potent and implementable interventions, while unveiling new avenues of science in which basic and applied goals are of equally high importance. Training in this integrated, translational model may help students learn how to conduct research in every domain of clinical science and at each stage of intervention development. This vision aims to propel the field to fulfill the public health goal of producing implementable and effective treatment and prevention interventions.
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The theory-practice gap in cognitive-behavior therapy. Behav Ther 2013; 44:541-7. [PMID: 24094779 DOI: 10.1016/j.beth.2013.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 03/20/2013] [Accepted: 03/21/2013] [Indexed: 11/21/2022]
Abstract
This special series is devoted to understanding the theory-practice gap in cognitive-behavior therapy (CBT). Although CBT enjoys considerable empirical support, and is widely recognized as an efficacious approach to a diversity of psychiatric disorders and includes many different forms of treatment, it is unclear whether clinicians are familiar with the underlying theories of the treatments they are practicing. Moreover, it is unclear to what degree an understanding of the theory is necessary for effective practice. Gaining clarity on the role of understanding underlying theory and identifying potential disparities between theory and practice may have implications for the way graduate training programs are structured and current professionals approach continuing education. A brief exploration of these implications will be offered by introducing issues related to the scientist-practitioner model and dissemination of efficacious treatments, in addition to an outline of potential advantages and disadvantages of knowing underlying theory. This special series will then feature several major approaches to treatment wherein the role of theory and practice are discussed.
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