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Bartuska AD, Eaton EL, Akinrimisi P, Kim R, Cheron DM, Park AL. Provider Adherence to Modular Cognitive Behavioral Therapy for Children and Adolescents. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:597-609. [PMID: 38334882 DOI: 10.1007/s10488-024-01353-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 02/10/2024]
Abstract
This study explored predictors of community-based providers' adherence to MATCH, a modular cognitive behavioral therapy for children and adolescents. Provider-reported adherence to MATCH was measured using three increasingly strict criteria: (1) session content (whether the session covered MATCH content consistent with the client's target problem), (2) session content and sequencing (whether the session covered MATCH content in the expected sequence for the client's target problem), and (3) session content, sequencing, and participant (whether the session covered MATCH content in the expected sequence and with the expected participant(s) for the client's target problem). Session, client, provider, and organizational predictors of adherence to MATCH were assessed using multilevel modeling. Results revealed that nearly all providers delivered MATCH content that corresponded to the target problem, but only one-third of providers delivered MATCH content in the expected sequence and with the expected participant for the client's target problem. This difference underscores the need for nuanced adherence measurement to capture important implementation information that broad operationalizations of adherence miss. Regardless of the criteria used providers were most adherent to MATCH during sessions when clients presented with interfering comorbid mental health symptoms. This suggests that the design of MATCH, which offers flexibility and structured guidance to address comorbid mental health problems, may allow providers to personalize treatment to address interfering comorbidity symptoms while remaining adherent to evidence-based practices. Additional guidance for providers on managing other types of session interference (e.g., unexpected events) may improve treatment integrity in community settings.
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Affiliation(s)
- Anna D Bartuska
- Department of Psychology, University of Oregon, Eugene, OR, USA.
| | - Emma L Eaton
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | | | - Rachel Kim
- The Baker Center for Children and Families, Boston, MA, USA
| | - Dan M Cheron
- The Baker Center for Children and Families, Boston, MA, USA
| | - Alayna L Park
- Department of Psychology, University of Oregon, Eugene, OR, USA
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Pickard K, Hendrix N, Guerra K, Brane N, Islam N. Examining provider decisions around the delivery and adaptation of a parent-mediated intervention within an Early Intervention system. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2384-2396. [PMID: 36950904 DOI: 10.1177/13623613231162149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
LAY ABSTRACT Parent-mediated interventions are an evidence-based practice for autism in which providers support caregivers in learning and applying strategies that support their child's development. Research has begun to study whether parent-mediated interventions can be effectively delivered in Part C Early Intervention systems. This research has been promising; however, it has been difficult to determine how Early Intervention providers deliver and adapt parent-mediated interventions to meet the needs of the families they serve. Examining how parent-mediated interventions are delivered and adapted may help us understand whether parent-mediated interventions are a good fit in these systems. The current study examined the delivery of an evidence-based parent-mediated intervention, Project ImPACT, when delivered by providers within an Early Intervention system. Results from 24 Early Intervention providers demonstrated that, on average, providers delivered Project ImPACT with higher quality during their time in training and consultation. However, there was also variability in how providers delivered Project ImPACT, with some delivering the program inconsistently, some increasing their quality throughout consultation, and others having consistently high-quality delivery. In addition, qualitative data demonstrated that a variety of events arose within Project ImPACT sessions that drove providers to adapt the program. Results suggest the importance of carefully examining how and why providers deliver evidence-based interventions within Early Intervention systems.
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Affiliation(s)
| | - Nicole Hendrix
- Emory University, USA
- Children's Healthcare of Atlanta, USA
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Motamedi M, Lau AS, Byeon YV, Yu SH, Brookman-Frazee L. Supporting Emotionally Exhausted Community Mental Health Therapists in Appropriately Adapting EBPs for Children and Adolescents. J Behav Health Serv Res 2023; 50:468-485. [PMID: 37430134 DOI: 10.1007/s11414-023-09844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/12/2023]
Abstract
Evidence-based practices (EBPs) are often adapted during community implementation to improve EBP fit for clients and the service context. Augmenting EBPs with additional dosing and content may improve fit. However, reducing EBP content can reduce EBP effectiveness. Using multilevel regression models, this study examined whether supportive program climate and program-furnished EBP-specific implementation strategies (e.g., materials, ongoing training, in-house experts) are associated with augmenting and reducing adaptations, and whether therapist emotional exhaustion moderated these associations. Data were collected from surveys completed by 439 therapists from 102 programs 9 years after a system-driven EBP implementation initiative. Supportive program climate was associated with more augmenting adaptations. Emotional exhaustion was a significant moderator. When organizations used more EBP-specific implementation strategies, more emotionally exhausted therapists reduced EBPs less and less emotionally exhausted therapists augmented EBPs more. Findings provide guidance on how organizations can support appropriate EBP adaptations in spite of therapist emotional exhaustion.
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Affiliation(s)
- Mojdeh Motamedi
- University of California San Diego, La Jolla, USA.
- Child and Adolescent Services Research Center, San Diego, USA.
| | - Anna S Lau
- University of California Los Angeles, Los Angeles, USA
| | | | | | - Lauren Brookman-Frazee
- University of California San Diego, La Jolla, USA
- Child and Adolescent Services Research Center, San Diego, USA
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How Do Treatment Protocols Affect the Use of Engagement Practices in Youth Mental Health Services? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:943-961. [PMID: 35920954 DOI: 10.1007/s10488-022-01210-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 06/24/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Treatment engagement poses challenges for youth mental health providers. With the expansion of evidence-based treatments (EBTs), providers face complex decisions regarding how to engage youth and families using available information sources. This study investigated how EBT protocols are associated with the selection and delivery of engagement practices. METHOD Twenty engagement practices were coded in a sample of digital recordings of early treatment sessions (N = 193) from the Child STEPs in California study, a randomized trial testing modular treatment and community-implemented treatment for youth mental health problems. Data were collected on which protocols mental health providers reportedly used to guide their sessions and the protocols in which they had received training. We examined which information sources (i.e., the guiding protocol, other protocols in training history, unspecified source) were associated with observed engagement practices. RESULTS In sessions guided by a protocol, most observed engagement practices were accounted for by the guiding protocol (p < .001), rather than protocols in training history or unspecified sources (p < .001). In sessions not guided by a protocol, most observed practices were accounted for by training history (p < .001). Practice frequency and extensiveness was generally greater when a protocol guided the session. CONCLUSIONS Inclusion in protocols is associated with the selection and delivery of engagement practices, but this strategy might be insufficient for supporting the use of the full range of engagement practices supported by evidence. Supports are needed that leverage the engagement evidence base to ensure that selected practices empirically fit the engagement needs of youth and families.
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Sjoberg H, Kenney RR, Morgan B, Connelly B, Jones CD, Ali HN, Battaglia C, Gilmartin HM. Adaptations to relational facilitation for two national care coordination programs during COVID-19. FRONTIERS IN HEALTH SERVICES 2022; 2:952272. [PMID: 36925807 PMCID: PMC10012763 DOI: 10.3389/frhs.2022.952272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Abstract
Background Adaptations to implementation strategies are often necessary to support adoption and scale-up of evidence-based practices. Tracking adaptations to implementation strategies is critical for understanding any impacts on outcomes. However, these adaptations are infrequently collected. In this article we present a case study of how we used a new method during COVID-19 to systematically track and report adaptations to relational facilitation, a novel implementation strategy grounded in relational coordination theory. Relational facilitation aims to assess and improve communication and relationships in teams and is being implemented to support adoption of two Quadruple Aim Quality Enhancement Research Initiative (QA QUERI) initiatives: Care Coordination and Integrated Case Management (CC&ICM) and the Transitions Nurse Program for Home Health Care (TNP-HHC) in the Veterans Health Administration (VA). Methods During 2021-2022, relational facilitation training, activities and support were designed as in-person and/or virtual sessions. These included a site group coaching session to create a social network map of care coordination roles and assessment of baseline relationships and communication between roles. Following this we administered the Relational Coordination Survey to assess the relational coordination strength within and between roles. COVID-19 caused challenges implementing relational facilitation, warranting adaptations. We tracked relational facilitation adaptations using a logic model, REDCap tracking tool based on the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) with expanded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) dimensions, and member checking. Adaptations were analyzed descriptively and for themes using matrix content analysis. Results COVID-19's impact within the VA caused barriers for implementing relational facilitation, warranting eight unique adaptations to the implementation strategy. Most adaptations pertained to changing the format of relational facilitation activities (n = 6; 75%), were based on external factors (n = 8; 100%), were planned (n = 8; 100%) and initiated by the QA QUERI implementation team (n = 8; 100%). Most adaptations impacted adoption (n = 6; 75%) and some impacted implementation (n = 2; 25%) of the CC&ICM and TNP-HHC interventions. Discussion Systematically tracking and discussing adaptations to relational facilitation during the COVID-19 pandemic enhanced engagement and adoption of two VA care coordination interventions. The impact of these rapid, early course adaptations will be followed in subsequent years of CC&ICM and TNP-HHC implementation.
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Affiliation(s)
- Heidi Sjoberg
- Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
| | - Rachael R. Kenney
- Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
| | - Brianne Morgan
- Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
| | - Brigid Connelly
- Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
| | - Christine D. Jones
- Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Hebatallah Naim Ali
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Catherine Battaglia
- Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
- Colorado School of Public Health, Department of Health Systems, Management and Policy, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Heather M. Gilmartin
- Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
- Colorado School of Public Health, Department of Health Systems, Management and Policy, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
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Swindle T, Rutledge JM, Martin J, Curran GM. Implementation fidelity, attitudes, and influence: a novel approach to classifying implementer behavior. Implement Sci Commun 2022; 3:60. [PMID: 35668517 PMCID: PMC9171954 DOI: 10.1186/s43058-022-00307-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background The current study sought to (1) describe a new classification approach for types of implementer behavior and (2) explore the implementer behavior change in response to tailored implementation facilitation based on the classifications. Methods A small-scale, cluster-randomized hybrid type III implementation trial was conducted in 38 early care and education classrooms that were part of the Together, We Inspire Smart Eating (WISE) program. WISE focuses on 4 evidence-based practices (EBPs), which are implemented by teachers to promote nutrition. External facilitators (N = 3) used a modified Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) to complete immersion (i.e., observations) and thematic content analyses of interviews to identify the characteristics of teachers’ behavior at varying levels of implementation fidelity. Three key factors—attitudes toward the innovation, fidelity/adaptations, and influence—were identified that the research team used to classify teachers’ implementation behavior. This process resulted in a novel classification approach. To assess the reliability of applying the classification approach, we assessed the percent agreement between the facilitators. Based on the teachers’ classification, the research team developed a tailored facilitation response. To explore behavior change related to the tailored facilitation, change in fidelity and classification across the school year were evaluated. Results The classifications include (1) enthusiastic adopters (positive attitude, meeting fidelity targets, active influence), (2) over-adapting adopters (positive attitude, not meeting fidelity targets, active influence), (3) passive non-adopters (negative attitude, not meeting fidelity targets, passive influence), and (4) active non-adopters (negative attitudes, not meeting fidelity targets, active influence). The average percent agreement among the three facilitators for classification was 75%. Qualitative data support distinct patterns of perceptions across the classifications. A positive shift in classification was observed for 67% of cases between the mid-point and final classification. Finally, we generated an expanded classification approach to consider additional combinations of the three factors beyond those observed in this study. Conclusions Data from this study support the ability to apply the classification approach with moderate to high reliability and to use the approach to tailor facilitation toward improved implementation. Findings suggest the potential of our approach for wider application and potential to improve tailoring of implementation strategies such as facilitation.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., #530, Little Rock, AR, 72205-7199, USA.
| | - Julie M Rutledge
- Education and Research in Children's Health Center, College of Applied and Natural Sciences, Louisiana Tech University, Ruston, USA
| | - Janna Martin
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., #530, Little Rock, AR, 72205-7199, USA
| | - Geoffrey M Curran
- Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, #522-472205-7199, USA.,Central Arkansas Veterans Healthcare System, 4300 W 7th St, Little Rock, AR, 72205, USA
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Yu-Lefler HF, Marsteller J, Riley AW. Outcomes Accountability Systems for Early Childhood Disruptive Behaviors: A Scoping Review of Availability. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:735-756. [DOI: 10.1007/s10488-022-01196-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
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Gumport NB, Harvey AG. Memory and learning for sleep and circadian treatment in serious mental illness treated in a community mental health setting. Behav Res Ther 2022; 149:104029. [PMID: 34995953 PMCID: PMC10883147 DOI: 10.1016/j.brat.2021.104029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/30/2021] [Accepted: 12/28/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Existing research has demonstrated that patient memory and learning of treatment contents are poor and poorer learning is associated with worse treatment outcome. Most prior studies have included individuals from only a single diagnostic group, offer limited data on possible contributors to poor memory and learning, and have included small samples recruited in university settings. This study sought to describe patient recall of treatment contents, describe patient learning of treatment contents, examine contributors to patient recall and learning of treatment contents, and examine the association of patient recall and learning of treatment contents with treatment outcome. METHODS Adults with serious mental illness and sleep and circadian dysfunction (N = 99) received the Transdiagnostic Intervention for Sleep and Circadian Dysfunction in a community mental health setting. Measures of recall, learning, age, years of education, symptom severity, and treatment outcome were collected at post-treatment and 6-month follow-up. RESULTS Recall and learning were poor, fewer years of education was associated with worse recall and learning, and recall and learning were not associated with treatment outcome. CONCLUSIONS The findings offer evidence that poor patient memory for, and learning of, treatment contents extends to community settings and are transdiagnostic concerns.
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Yu SH, Brookman-Frazee L, Kim JJ, Barnett ML, Wright B, Lau AS. Therapist adaptations to evidence-based practices and associations with implementation outcomes in child therapy sessions. J Consult Clin Psychol 2022; 90:39-50. [PMID: 34410750 PMCID: PMC8857284 DOI: 10.1037/ccp0000667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Community therapists inevitably adapt evidence-based practices (EBPs) to meet the needs of their clients and practice settings. Yet, the implications of spontaneous, therapist-driven adaptations for EBP implementation outcomes are not well understood. We used a sequential QUAN → qual mixed-methods design to examine how different types of therapist-described adaptations were associated with observer-rated extensiveness of therapist delivery of EBP content and technique strategies at the session level. METHOD Data were drawn from an observational study of a system-driven implementation of multiple EBPs into public children's mental health services. Community therapists (n = 103) described adaptations they made in 680 sessions with 273 clients (50.92% female, 49.08% male, Mage = 9.72 years, 70.70% Hispanic/Latinx). Coders classified therapist-described adaptations into five types: (a) Modifying Presentation, (b) Integrating, (c) Extending, (d) Reducing, and (e) Generalizing. Independent observers rated the extensiveness of EBP strategy delivery from session recordings using the EBP Concordant Care Assessment (ECCA) Observational Coding System. RESULTS Quantitative analyses using multilevel regression revealed that Modifying Presentation adaptations were associated with higher extensiveness of EBP technique delivery, whereas Extending adaptations were associated with lower extensiveness of EBP content and technique delivery. Qualitative analysis of adaptation descriptions identified explanations for the quantitative findings. CONCLUSIONS Findings suggest that Modifying Presentation adaptations, associated with higher extensiveness, involved creative use of activities and materials, language modification, and personalization of EBP content to meet clients' diverse needs, whereas Extending adaptations, associated with lower extensiveness, involved slowing EBP pacing in response to client challenges. Implications for provider training are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Stephanie H. Yu
- Department of Psychology, University of California, Los Angeles, CA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, CA,Child and Adolescent Services Research Center (CASRC), San Diego, CA
| | - Joanna J. Kim
- Department of Psychology, Arizona State University, Phoenix, AZ
| | - Miya L. Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, CA
| | - Blanche Wright
- Department of Psychology, University of California, Los Angeles, CA
| | - Anna S. Lau
- Department of Psychology, University of California, Los Angeles, CA
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Scott E, Casavan K, Swigonski N. Interconception Care and Safe Sleep: Adapting the IMPLICIT Toolkit for Pediatrics. Pediatrics 2021; 148:peds.2020-016253. [PMID: 34642233 DOI: 10.1542/peds.2020-016253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A woman's health in the interconception period has an impact on birth outcomes. Pediatric visits offer a unique opportunity to provide interconception care (ICC). Our aim was to screen and provide interconception and safe sleep screening, counseling, and interventions for 50% of caregivers of children <2 years of age in a pediatric medical setting. METHODS Two pediatric clinics implemented the March of Dimes' Interventions to Minimize Preterm and Low Birth Weight Infants Through Continuous Improvement Techniques (IMPLICIT) toolkit, in addition to standardized safe sleep assessments. A quality improvement learning collaborative was formed with a local "infant mortality champion" leading quality improvement efforts. Monthly webinars with the clinic teams reviewed project successes and challenges. Framework for Reporting Adaptations and Modifications was used to document adaptations. RESULTS For each individual IMPLICIT domain, clinics screened and provided needed interventions for ICC and safe sleep in >50% of eligible encounters. Over the course of the quality improvement learning collaborative, the number of caregivers screened for at least 4 of the 5 IMPLICIT domains increased from 0% to 95%. CONCLUSIONS To successfully implement the IMPLICIT toolkit in pediatrics, adaptations were made to the existing model, which had previously been used in family medicine clinics. Pediatricians should consider providing ICC as an innovative way to impact infant mortality rates in their community. Framework for Reporting Adaptations and Modifications can be used to systematically describe the adaptations needed to improve the fit of IMPLICIT in the pediatric clinic, understand the process of change and potential application to local context.
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Affiliation(s)
- Emily Scott
- School of Medicine, Indiana University, Indianapolis, Indiana .,Riley Children's Health, Indianapolis, Indiana
| | - Kara Casavan
- School of Medicine, Indiana University, Indianapolis, Indiana
| | - Nancy Swigonski
- School of Medicine, Indiana University, Indianapolis, Indiana.,Riley Children's Health, Indianapolis, Indiana.,Division of Health Policy and Management, Fairbanks School of Public Health, Indianapolis, Indiana
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Lui JHL, Brookman-Frazee L, Lind T, Le K, Roesch S, Aarons GA, Innes-Gomberg D, Pesanti K, Lau AS. Outer-context determinants in the sustainment phase of a reimbursement-driven implementation of evidence-based practices in children's mental health services. Implement Sci 2021; 16:82. [PMID: 34412666 PMCID: PMC8375074 DOI: 10.1186/s13012-021-01149-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there is increasing investment to implement evidence-based practices (EBPs) in public systems across the USA, continued or sustained use of EBPs after initial implementation remains a challenge. The low integration of EBPs in routine practice severely limits their public health impact, highlighting the need to understand factors that affect the return on costly investments in EBP implementation. This study aims to (1) characterize trajectories of EBP delivery volume through a reimbursement-driven implementation and (2) examine impacts of system-level policy regulatory activity and state-level mental health services funding on the implementation reimbursement strategy. METHODS This study involved secondary data analyses. Psychotherapy administrative claims and regulatory site visit data from the Los Angeles County Department of Mental Health and California state mental health expenditures were extracted from 2010 to 2017. Multilevel regression examined EBP claims volume over time with state expenditures and regulatory compliance as predictors. RESULTS EBP claims volume trajectories demonstrated a rapid initial increase, followed by a period of decrease, and a small increase in the final year. State mental health expenditures increased across time reflecting increased funding availability. State mental health expenditures and system regulatory compliance were inversely related to EBP claims volume. CONCLUSIONS The impact of reimbursement-driven EBP implementation strategy is sensitive to multiple outer-context determinants. At the system level, commitment to fidelity of implementation regulations resulted in reduced use of the reimbursement strategy. Alternative reimbursement streams not tied to EBPs coupled with an expanded array of reimbursable services also impacted the use of the reimbursement strategy to implement EBPs.
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Affiliation(s)
- Joyce H L Lui
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA.
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Teresa Lind
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Kenny Le
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Scott Roesch
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | | | - Keri Pesanti
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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Hurwitz S, Garman-McClaine B, Carlock K. Special education for students with autism during the COVID-19 pandemic: "Each day brings new challenges". AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:889-899. [PMID: 34344221 DOI: 10.1177/13623613211035935] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT The novel coronavirus (COVID-19) disrupted how special educators provided supports and services for students with autism spectrum disorder. School closures and the related pivoting between learning modalities (i.e. virtual, hybrid, and face-to-face) were difficult for all students, but especially for students with autism, who rely on routine and require individualized instruction. In this study, we surveyed 106 special education teachers, behavior specialists, and speech pathologists who work with autistic students to learn about how they adapted instruction to comply with the complex social distancing rules and changing expectations of the pandemic. Participants reported "making the best out of a bad situation" and "constantly using 'trial & error' to find the best way for our students to eLearn." They emphasized the importance of collaboration with parents, who helped deliver intervention and monitor progress across settings. They made alterations to Individualized Education Programs, by adding individualized contingency learning plans, adjusting service minutes, and sometimes eliminating social goals. Participants were surprised that while students with more intense needs struggled, others actually preferred virtual instruction. This raises concerns for what will happen in the future, when social expectations resume. Despite the overwhelming challenges posed by COVID-19, participants demonstrated remarkable resiliency and an innovative ability to adapt instruction.
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Bailin A, Burton S, Rego S, Alpert J, Pimentel S. Integrating Advocacy for Marginalized Children and Families Into Evidence-Based Care During COVID-19: Clinical Vignettes. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:701-715. [PMID: 33994768 PMCID: PMC8112892 DOI: 10.1016/j.cbpra.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/19/2021] [Indexed: 01/17/2023]
Abstract
The novel coronavirus (COVID-19) has disproportionately impacted the health and socioeconomic outcomes for low-income populations, people of color, and immigrant children and families in the United States. As inequities in resources (i.e., food, internet, housing), health care, and education increased for marginalized families as a result of COVID-19, child-focused clinicians had to broaden their professional scope and implement new advocacy efforts. The current paper uses clinical vignettes taken from a New York State Office of Mental Health-licensed child and adolescent outpatient clinic in the Bronx, New York. The vignettes highlight the social inequities that impacted marginalized children and families during the pandemic, as well as the clinical team's response through the integration of evidence-base practice and advocacy. Implications for practice with vulnerable populations as the COVID-19 pandemic persists are discussed.
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Affiliation(s)
| | | | - Simon Rego
- Montefiore Medical Center/Albert Einstein, College of Medicine
| | - Jonathan Alpert
- Montefiore Medical Center/Albert Einstein, College of Medicine
| | - Sandra Pimentel
- Montefiore Medical Center/Albert Einstein, College of Medicine
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Harvey AG, Lammers HS, Dolsen MR, Mullin AC, Hilmoe HE, Tran M, Portnova V, Tuck AB, Mallidi A, Fang A, Byrnes C, Kao E, Lee C. Systematic review to examine the methods used to adapt evidence-based psychological treatments for adults diagnosed with a mental illness. EVIDENCE-BASED MENTAL HEALTH 2020; 24:33-40. [PMID: 33355291 DOI: 10.1136/ebmental-2020-300225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/28/2020] [Accepted: 12/07/2020] [Indexed: 11/03/2022]
Abstract
QUESTION The context for the implementation of evidence-based psychological treatments (EBPTs) often differs from the context in which the treatment was developed, which necessitates adaptations. In this systematic review we build on, and add to, prior approaches by examining the method used to guide such adaptations. In particular, we sought to elucidate the extent to which an empirical process is used. STUDY SELECTION AND ANALYSIS We focused on publications describing adaptations made to EBPTs for adults diagnosed with a mental illness. We searched PubMed, PsycINFO, Embase and Web of Science from database inception to July 2018. Two raters independently coded the articles for the method used to conduct the adaptation, the reason for and nature of the adaptation, and who made the adaptation. FINDINGS The search produced 20 194 citations, which yielded 152 articles after screening. The most commonly used methods for planned adaptations were literature review (57.7%), clinical intuition (47.0%) and theory (38.9%). The use of data from stakeholder interviews ranked fourth (21.5%) and the use of other types of data (eg, pilot study, experiment, survey, interview) ranked last at fifth (12.1%). Few publications reporting ad hoc adaptations were identified (n=3). CONCLUSIONS This review highlights a need to (a) educate providers and researchers to carefully consider the methods used for the treatment adaptation process, and to use empirical methods where possible and where appropriate, (b) improve the quality of reporting of stakeholder interviews and (c) develop reporting standards that articulate optimal methods for conducting treatment adaptations.
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Affiliation(s)
- Allison G Harvey
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Hannah S Lammers
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Michael R Dolsen
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Alice C Mullin
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Heather E Hilmoe
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Melanie Tran
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Vera Portnova
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Alison B Tuck
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Ajitha Mallidi
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Anya Fang
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Caitlin Byrnes
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Esther Kao
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Colin Lee
- Psychology, University of California Berkeley, Berkeley, California, USA
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Gumport NB, Yu SH, Harvey AG. Implementing a transdiagnostic sleep and circadian intervention in a community mental health setting: A qualitative process evaluation with community stakeholders. Psychiatry Res 2020; 293:113443. [PMID: 32890862 DOI: 10.1016/j.psychres.2020.113443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
The implementation of evidence-based psychological treatments (EBPTs) may be particularly challenging to accomplish in community mental health settings for individuals with severe mental illness (SMI). Transdiagnostic treatments, or treatments that target a mechanism that underpins multiple mental health problems, may be particularly well-suited to community mental health settings. This study examines community stakeholder perspectives (N = 22) of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) implemented in a community mental health setting in the context of a randomized controlled trial of TranS-C for SMI. The present study aimed to identify barriers and facilitators to the implementation of TranS-C for SMI in a community mental health setting using (1) a deductive theory-based process based on the Framework for Dissemination in Health Services Intervention Research and (2) an inductive thematic analysis process. All deductive themes were identified as both barriers and facilitators to the implementation of EBPTs and TranS-C in this community mental health setting. Seven additional themes were identified through the inductive thematic analysis. A discussion of how the findings are related to prior research, other EBPT implementation, and future TranS-C implementation are included.
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Affiliation(s)
- Nicole B Gumport
- Department of Psychology, University of California, 2121 Berkeley Way #1650, Berkeley, CA, United States
| | - Stephanie H Yu
- Department of Psychology, University of California, 2121 Berkeley Way #1650, Berkeley, CA, United States; Department of Psychology, University of California, Los Angeles, CA, United States
| | - Allison G Harvey
- Department of Psychology, University of California, 2121 Berkeley Way #1650, Berkeley, CA, United States.
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Stadnick NA, Aarons GA, Blake L, Brookman-Frazee LI, Dourgnon P, Engell T, Jusot F, Lau AS, Prieur C, Skar AMS, Barnett ML. Leveraging implementation science to reduce inequities in Children's mental health care: highlights from a multidisciplinary international colloquium. BMC Proc 2020; 14:2. [PMID: 32280371 PMCID: PMC7132860 DOI: 10.1186/s12919-020-00184-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Access to evidence-based mental health care for children is an international priority. However, there are significant challenges to advancing this public health priority in an efficient and equitable manner. The purpose of this international colloquium was to convene a multidisciplinary group of health researchers to build an agenda for addressing disparities in mental health care access and treatment for children and families through collaboration among scholars from the United States and Europe engaged in innovative implementation science and mental health services research. KEY HIGHLIGHTS Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework, presentations related to inner, outer, and bridging context factors that impact the accessibility and quality of mental health evidence-based practices (EBPs) for children and families. Three common topics emerged from the presentations and discussions from colloquium participants, which included: 1) the impact of inner and outer context factors that limit accessibility to EBPs across countries, 2) strategies to adapt EBPs to improve their fit in different settings, 3) the potential for implementation science to address emerging clinical and public health concerns. IMPLICATIONS The common topics discussed underscored that disparities in access to evidence-based mental health care are prevalent across countries. Opportunities for cross-country and cross-discipline learnings and collaborations can help drive solutions to address these inequities, which relate to the availability of a trained and culturally appropriate workforce, insurance reimbursement policies, and designing interventions and implementation strategies to support sustained use of evidence-based practices.
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Affiliation(s)
- Nicole A. Stadnick
- University of California San Diego, La Jolla, CA 92093 USA
- Child and Adolescent Services Research Center, San Diego, CA 92123 USA
- University of California San Diego Dissemination and Implementation Science Center, La Jolla, CA 92093 USA
| | - Gregory A. Aarons
- University of California San Diego, La Jolla, CA 92093 USA
- Child and Adolescent Services Research Center, San Diego, CA 92123 USA
- University of California San Diego Dissemination and Implementation Science Center, La Jolla, CA 92093 USA
| | - Lucy Blake
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, Lancashire UK
| | - Lauren I. Brookman-Frazee
- University of California San Diego, La Jolla, CA 92093 USA
- Child and Adolescent Services Research Center, San Diego, CA 92123 USA
- University of California San Diego Dissemination and Implementation Science Center, La Jolla, CA 92093 USA
- Autism Discovery Institute, Rady Children’s Hospital, San Diego, USA
| | - Paul Dourgnon
- Institut de Recherche et Documentation en Economie de la Santé, Paris, France
| | - Thomas Engell
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Florence Jusot
- Institut de Recherche et Documentation en Economie de la Santé, Paris, France
- Université Paris-Dauphine, Paris, France
| | - Anna S. Lau
- Child and Adolescent Services Research Center, San Diego, CA 92123 USA
- University of California, Los Angeles, Los Angeles, CA 90095 USA
| | | | | | - Miya L. Barnett
- Child and Adolescent Services Research Center, San Diego, CA 92123 USA
- University of California, Santa Barbara, Santa Barbara, CA 93106 USA
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