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Lau AS, Lind T, Cox J, Motamedi M, Lui JHL, Chlebowski C, Flores A, Diaz D, Roesch S, Brookman-Frazee L. Validating a Pragmatic Measure of Evidence-Based Practice (EBP) Delivery: Therapist Reports of EBP Strategy Delivery and Associations with Child Outcome Trajectories. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01395-x. [PMID: 39096408 DOI: 10.1007/s10488-024-01395-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 08/05/2024]
Abstract
Pragmatic measures of evidence-based practice (EBP) implementation can support and evaluate implementation efforts. We examined the predictive validity of therapist reports of EBP strategy delivery for children's mental health outcomes. Data were obtained from 1,380 sessions with 248 children delivered by 76 therapists in two county systems. Children (Mage=11.8 years, SD = 3.7) presented with internalizing (52%), externalizing (27%), trauma (16%), and other (5%) concerns. Therapists reported their delivery of EBP strategies on a revised version of the EBP Concordant Care Assessment (ECCA; Brookman-Frazee, et al., Administration and Policy in Mental Health and Mental Health Services Research, 48, 155-170, 2021) that included 25 content (e.g., parenting, cognitive behavioral) and 12 technique strategies (e.g., modeling, practice/role-play). On average, 5.6 ECCA session reports (SD = 2.3) were obtained for each client, and caregivers reported symptoms on the Brief Problem Checklist (Chorpita, et al., Journal of Consulting and Clinical Psychology, 78(4), 526-536, 2010) at baseline, weekly over two months, and again at four months. Multilevel models examined whether the mean extensiveness of each EBP strategy predicted trajectories of child outcomes. More individual technique (6 of 12) than content strategies (1 of 25) were associated with outcome trajectories. For techniques, more extensive use of Performance Feedback and Live Coaching and less extensive use of Addressing Barriers were associated with greater declines in total symptoms, and more extensive use of Establishing/Reviewing Goals, Tracking/Reviewing Progress, and Assigning/Reviewing Homework was associated with declines in externalizing symptoms. For content, more extensive use of Cognitive Restructuring was associated with declines in total symptoms. In addition, higher average extensiveness ratings of the top content strategy across sessions was associated with greater declines in total and externalizing symptoms. Therapist-reported delivery of some EBP strategies showed evidence of predictive validity and may hold utility in indexing quality of care.
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Affiliation(s)
- Anna S Lau
- Department of Psychology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Teresa Lind
- Department of Child and Family Development, San Diego State University, San Diego, CA, USA.
- Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA.
| | - Julia Cox
- Department of Psychology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Mojdeh Motamedi
- Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA
- Department of Psychiatry, University of California-San Diego, La Jolla, CA, USA
| | - Joyce H L Lui
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Colby Chlebowski
- Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Ashley Flores
- Department of Psychology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Devynne Diaz
- Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA
- Department of Psychiatry, University of California-San Diego, La Jolla, CA, USA
| | - Scott Roesch
- Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA
- Department of Psychiatry, University of California-San Diego, La Jolla, CA, USA
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Lyons MJ, J Whitaker D, Self-Brown S, A Weeks E. A Longitudinal Analysis of Trajectories and Predictors of Fidelity Using the SafeCare Parenting Model. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:240-253. [PMID: 38183521 DOI: 10.1007/s10488-023-01336-0] [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: 12/13/2023] [Indexed: 01/08/2024]
Abstract
Evidence-based practice (EBP) fidelity, understood as the extent to which a program is implemented as the developers intended, is a key implementation variable which likely relates to consumer outcomes. However, studies that track fidelity longitudinally and at large scale are uncommon, and finding reliable predictors of fidelity has proven to be a complex challenge. Further, attitudes toward EBP are a potentially important predictor of fidelity, but results across the literature have been mixed. The purpose of the present study is to use data from the ongoing implementation and dissemination of the SafeCare model to better understand (1) the characteristics of SafeCare implementation fidelity trajectories, and (2) whether individual level factors predict differences in fidelity and fidelity trajectories, especially provider attitudes toward EBP. The analyses reported here include 14,778 observed fidelity sessions by 868 providers in 172 agencies. We use multilevel modeling to examine fidelity, fidelity trajectories over time, and several potential individual-level predictors of fidelity, including demographics, work history, and attitudes toward EBP. We found: (1) that SafeCare fidelity begins high at baseline (93.85% on average); (2) that SafeCare fidelity displays a statistically significant trend of positive linear growth, even among those with less positive attitudes; and (3) that positive attitudes are associated with slightly higher fidelity on average and at baseline, while negative attitudes are associated with slightly lower fidelity on average and at baseline. To our knowledge, this is the largest longitudinal analysis of EBP fidelity in a child welfare program to date, and our findings support the notion that intensive coaching supports which are titrated over time can be sufficient to ensure sustained high fidelity, at least in some cases. Further, these findings indicate that robust training and coaching processes can ensure high fidelity and fidelity growth even among providers with less positive attitudes toward EBP.
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Affiliation(s)
- Matthew Jay Lyons
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, USA.
| | | | | | - Erin A Weeks
- School of Public Health, Georgia State University, Atlanta, USA
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Johnson C, AlRasheed R, Gray C, Triplett N, Mbwayo A, Weinhold A, Whetten K, Dorsey S. Uncovering determinants of perceived feasibility of TF-CBT through coincidence analysis. IMPLEMENTATION RESEARCH AND PRACTICE 2024; 5:26334895231220277. [PMID: 38322800 PMCID: PMC10775737 DOI: 10.1177/26334895231220277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Introduction A mental health provider's perception of how well an intervention can be carried out in their context (i.e., feasibility) is an important implementation outcome. This article aims to identify determinants of feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) through a case-based causal approach. Method Data come from an implementation-effectiveness study in which lay counselors (teachers and community health volunteers) implemented a culturally adapted manualized mental health intervention, TF-CBT, delivered to teens who were previously orphaned and were experiencing posttraumatic stress symptoms and prolonged grief in Western Kenya. The intervention team identified combinations of determinants that led to feasibility among teacher- and community health volunteer-counselors through coincidence analysis. Results Among teacher-counselors, organizational-level factors (implementation climate, implementation leadership) determined moderate and high levels of feasibility. Among community health volunteer-counselors, a strong relationship between a clinical supervisor and the supervisee was the most influential determinant of feasibility. Conclusion Methodology and findings from this article can guide the assessment of determinants of feasibility and the development of implementation strategies for manualized mental health interventions in contexts like Western Kenya. Plain Language Summary A mental health provider's perception of how easy a therapy is to use in their work setting (i.e., feasibility) can impact whether the provider uses the therapy in their setting. Implementation researchers have recommended finding practices and constructs that lead to important indicators that a therapy will be used. However, limited research to our knowledge has searched and found practices and constructs that might determine feasibility of a therapy. This article uses existing data from a large trial looking at the continued use of a trauma-focused therapy to find practices and constructs that lead to moderate and high levels of feasibility. We found that in settings with a strong organizational structure that organization and leadership support for the therapy led to teachers in Kenya to perceive the therapy as easy to use. On the other hand, in settings with a weaker organizational structure, outside support from a clinical supervisor led to community health volunteers in Kenya perceiving the therapy as easy to use. The findings from this article can guide context-specific recommendations for increasing perceived therapy feasibility at the provider-, organization-, and policy levels.
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Affiliation(s)
- Clara Johnson
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Rashed AlRasheed
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Christine Gray
- Center for Health Policy and Inequities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Noah Triplett
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Andrew Weinhold
- Center for Health Policy and Inequities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Kathryn Whetten
- Center for Health Policy and Inequities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
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Doctoral clinical psychology student commentary on common myths about CBT: lessons learned for competency-based training. COGNITIVE BEHAVIOUR THERAPIST 2023. [DOI: 10.1017/s1754470x23000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Effective methods for training and education in the dissemination of evidence-based treatments is a priority. This commentary provides doctoral clinical psychology graduate student authors perspectives on common myths about cognitive behavioural therapy (CBT). Three myths were identified and considered: (1) CBT does not value the therapeutic relationship; (2) CBT is overly rigid; and (3) exposure techniques are cruel. Graduate students were engaged in a competency-based course in Cognitive Behavioural Approaches to Psychotherapy at an American Psychological Association (APA)-accredited doctoral clinical psychology program. The origins of common myths identified by graduate students included a lack of in-depth coverage of CBT and brief video segments provided during introductory courses, lived experience with CBT, and pre-determined views of manualized treatment and exposure techniques. Myth-addressing factors discussed by graduate students included holding space at the start of training for a discussion of attitudes about CBT, specific learning activities, and course content described in this commentary. Finally, self-reported changes in graduate students’ attitudes and behaviour following the course included a more favourable view of CBT as valuing the therapeutic relationship, as well as implementation of resources provided, and techniques learned and practised at practicum settings. Limitations and lessons learned are discussed through the lens of a model of adult learning that may be applied to future graduate training in evidence-based therapies like CBT.
Key learning aims
(1)
To understand common myths about cognitive behavioural therapy (CBT) that doctoral students in clinical psychology hold prior to entering a course in CBT.
(2)
To understand the possible origins of these myths, factors that may address their impacts, and changes in attitudes and behaviour among graduate students as a result.
(3)
To examine the lessons learned that can be applied to future training in evidence-based therapies like CBT.
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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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Morena AL, Gaias LM, Larkin C. Understanding the Role of Clinical Champions and Their Impact on Clinician Behavior Change: The Need for Causal Pathway Mechanisms. FRONTIERS IN HEALTH SERVICES 2022; 2:896885. [PMID: 36925794 PMCID: PMC10012807 DOI: 10.3389/frhs.2022.896885] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022]
Abstract
Background The clinical champion approach is a highly utilized implementation strategy used to mitigate barriers and improve outcomes of implementation efforts. Clinical champions are particularly effective at addressing provider-level barriers and promoting provider-behavior change. Yet, the specific causal pathways that explain how clinical champions impact provider behavior change have not been well-explicated. The current paper applies behavior change models to develop potential causal pathway mechanisms. Methods The proposed mechanisms are informed by previous literature involving clinical champions and empirically supported behavior change models. These models are applied to link specific attributes to different stages of behavior change and barriers for providers. Results Two unique pathway mechanisms were developed, one that explicates how providers develop intention to use EBPs, while the other explicates how providers transition to EBP use and sustainment. Clinical champions may promote intention development through behavioral modeling and peer buy-in. In contrast, champions promote behavioral enactment through skill building and peer mentorship. Conclusion Clinical champions likely play a critical role in reducing provider implementation barriers for providers across various phases of behavior change. The proposed pathways provide potential explanations for how clinical champions promote provider behavior change. Future research should prioritize empirically testing causal pathway mechanisms.
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Affiliation(s)
- Alexandra L. Morena
- Department of Psychology, University of Massachusetts, Lowell, MA, United States
| | - Larissa M. Gaias
- Department of Psychology, University of Massachusetts, Lowell, MA, United States
| | - Celine Larkin
- University of Massachusetts Chan Medical School, Worcester, MA, United States
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Patel ZS, Philips D, Casline E, Aarons GA, Maxwell CA, Ginsburg GS, Ehrenreich-May J, Jensen-Doss A. WHO Participates in Effectiveness Research? A Comparison of Effectiveness Trial Clinicians to National Survey Samples. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:899-908. [PMID: 35701676 PMCID: PMC9393133 DOI: 10.1007/s10488-022-01202-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/13/2022]
Abstract
Findings from research participants in effectiveness treatment trials (i.e., randomized control trials conducted in community rather than research settings) are considered more generalizable than those from participants in efficacy trials. This is especially true for clinician participants, whose characteristics like attitudes towards evidence-based practices (EBPs) may impact treatment implementation and the generalizability of research findings from effectiveness studies. This study compared background characteristics, attitudes toward EBPs, and attitudes towards measurement-based care (MBC) among clinicians participating in a National Institute of Mental-Health (NIMH) funded effectiveness trial, the Community Study of Outcome Monitoring for Emotional Disorders in Teens (COMET), to clinician data from nationally representative U.S. survey samples. Results indicated COMET clinicians were significantly younger, less clinically experienced, and were more likely to have a training background in psychology versus other disciplines compared to national survey samples. After controlling for demographics and professional characteristics, COMET clinicians held more positive attitudes towards EBPs and MBC compared to national survey samples. Implications for implementation efforts are discussed.
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Affiliation(s)
- Zabin S Patel
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA.
| | - Dominique Philips
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
| | - Elizabeth Casline
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA
| | - Colleen A Maxwell
- Department of Psychology, Temple University, Philadelphia, PA, 19122, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut, Farmington, CT, 06030, USA
| | | | - Amanda Jensen-Doss
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
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Speers AJ, Bhullar N, Cosh S, Wootton BM. Correlates of therapist drift in psychological practice: A systematic review of therapist characteristics. Clin Psychol Rev 2022; 93:102132. [DOI: 10.1016/j.cpr.2022.102132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 07/10/2021] [Accepted: 02/13/2022] [Indexed: 11/03/2022]
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Sibley MH, Ortiz M, Rios-Davis A, Zulauf-McCurdy CA, Graziano PA, Bickman L. Stakeholder-Generated Implementation Strategies to Promote Evidence-Based ADHD Treatment in Community Mental Health. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:44-58. [PMID: 33988847 DOI: 10.1007/s10488-021-01143-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Community implementation of evidence-based practices (EBPs) for Attention Deficit/Hyperactivity Disorder (ADHD) is greatly lacking. A recent randomized community-based trial of an EBP for ADHD (Supporting Teens' Autonomy Daily; STAND) demonstrated suboptimal implementation and effectiveness outcomes. In the present study, we conducted an Innovation Tournament (IT) with agency staff stakeholders (N = 26) to identify barriers to successful implementation of STAND and implementation strategies for a revised service delivery model. We conducted member-checking of agency staff-generated ideas with parents (N = 226) and subsequent querying of additional parent (N = 226) and youth-generated (N = 205) strategies to improve care. Go-Zone plots were utilized to identify strategies with the highest feasibility and importance. Practical barriers (i.e., transportation, scheduling difficulties) and parent/youth engagement were the most commonly cited obstacles to successful implementation of STAND in community contexts. Eighteen "winning" implementation strategies were identified that survived member checking. These were classified as train and educate stakeholders (n = 5; e.g., train agency supervisors to deliver supervision, digitize treatment materials and trainings), engage consumers (n = 9; e.g., begin treatment with rapport building sessions, increase psychoeducation), provide interactive assistance (n = 2; e.g., add group supervision, increase roleplay in supervision), and use of evaluative/iterative strategies (n = 2; e.g., perform fidelity checks, supervisor review of session recordings). Parents and youth desired longer duration of treatment and increased focus on maintenance. Strategies will be developed and tested as part of a pilot effectiveness trial designed to refine STAND's service delivery model.Trial Registration NCT02694939 www.clinicaltrials.gov.
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Affiliation(s)
- Margaret H Sibley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
- Seattle Children's Research Institute, Seattle, WA, USA.
| | | | | | - Courtney A Zulauf-McCurdy
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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Chu SY, Hara Y, Wong CH, Higashikawa M, McConnell GE, Lim A. Exploring attitudes about evidence-based practice among speech-language pathologists: A survey of Japan and Malaysia. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:662-671. [PMID: 33823717 DOI: 10.1080/17549507.2021.1877816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose: To investigate speech-language pathologists' current perceptions, previous training experiences, resources, barriers, and training needs in terms of evidence-based practices (EBPs) in two Asian countries.Method: Their knowledge and attitudes about EBP were explored using an online questionnaire. A descriptive analysis was conducted with consideration of the effect of demographic variables on knowledge and attitudes about EBP.Result: Malaysian speech-language pathologists (n = 98) displayed more positive attitudes toward EBPs, with a significantly higher (t (143) = 5.91, p < .01) total mean score (Mean = 120.7, SD = 11) compared to the Japanese speech-language pathologists (n = 47, Mean = 107.8, SD = 13.5). Malaysian practitioners who were female, worked full-time, and worked in government settings reported higher motivation to develop EBP skills. Japanese practitioners who worked in private sectors reported higher EBPs training needs than those in government settings. In both countries, speech-language pathologists with higher education levels tended to express fewer perceived barriers towards EBP.Conclusion: Findings could help local governance and speech-language pathologist associations to understand the current practices and professional development needs of speech-language pathologists, leading to more effective training programs and educating employers and managers who can reinforce EBP among practitioners.
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Affiliation(s)
- Shin Ying Chu
- Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (H-CARE), Speech Sciences Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yuki Hara
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Chiew Hock Wong
- Faculty of Health Sciences, Speech Sciences Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mari Higashikawa
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Grace E McConnell
- Communication Sciences and Disorders, College of Health and Human Services, Rockhurst University, Kansas City, Missouri, USA
| | - Annette Lim
- Faculty of Health Sciences, Speech Sciences Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Newhart S, Travis S, Mullen PR. Factors Predicting Attitudes Toward Evidence‐Based Practice Among College Counselors. JOURNAL OF COLLEGE COUNSELING 2021. [DOI: 10.1002/jocc.12191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Sean Newhart
- Department of Counseling and Educational Studies Johns Hopkins University
| | - Sterling Travis
- Department of Counseling and Educational Studies Johns Hopkins University
| | - Patrick R. Mullen
- Department of School Psychology and Counselor Education William and Mary
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12
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Ayhan Başer D, Ağadayi E, Gönderen Çakmak S, Kahveci R. Adaptation of the evidence-based practices attitude scale-15 in Turkish family medicine residents. Int J Clin Pract 2021; 75:e14354. [PMID: 33974348 DOI: 10.1111/ijcp.14354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 11/28/2022] Open
Abstract
AIMS Aim of this study is to translate and apply a cross-cultural adaptation of the Evidence-Based Practice Attitude Scale (EBPAS) in Turkish and investigate its validity and reliability. METHODS The original EBPAS-15 (a questionnaire assessing health professionals' attitudes to implementation of evidence-based practice) was translated into Turkish. To assess its validity and reliability, 151 family medicine residents answered the EBPAS-15 by web-based survey. In addition, relationships of family medicine residents' characteristics with EBPAS-15 total scores are examined. RESULTS The results showed that the EBPAS-15 has good internal consistency and reliability. The Cronbach's alpha value for EBPAS-15 was 0.828. The scores of the two scales were highly correlated (ρ = 0.72). In the scale, there was no item with a total correlation value of less than 0.40. For this reason, no item was removed due to the high reliability value of all 15 items. CONCLUSION The Turkish version of the EBPAS-15 shows mainly good validity and reliability.
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Affiliation(s)
- Duygu Ayhan Başer
- Department of Family Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ezgi Ağadayi
- Department of Medical Education, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | | | - Rabia Kahveci
- Department of Family Medicine, Ankara City Hospital, Ankara, Turkey
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Meza RD, Triplett NS, Woodard GS, Martin P, Khairuzzaman AN, Jamora G, Dorsey S. The relationship between first-level leadership and inner-context and implementation outcomes in behavioral health: a scoping review. Implement Sci 2021; 16:69. [PMID: 34229706 PMCID: PMC8259113 DOI: 10.1186/s13012-021-01104-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 03/19/2021] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND First-level leadership is uniquely positioned to support evidence-based practice (EBP) implementation for behavioral health due to first-level leaders' access to and relationship with service providers. First-level leaders are individuals who directly supervise and manage frontline employees who do not manage others. However, first-level leadership is underrepresented in existing reviews of the impact of leadership on EBP implementation. This review describes the relationship between first-level leadership and implementation determinants and outcomes. METHODS A scoping review was performed to synthesize the literature on the relationship between first-level leadership and inner-context and implementation outcomes. A literature search was conducted in PubMed, Eric, PsycINFO, CINAHL, Scopus, and Web of Science. To be eligible, studies had to examine first-level leadership, be conducted in settings providing behavioral health services, and examine the relationship between first-level leadership and an implementation or inner-context outcome. Data extraction and synthesis were performed to describe study characteristics, leader-outcome relationships, and overlap in leadership frameworks. RESULTS Twenty-one records met our inclusion criteria. Studies primarily relied on observational designs and were often cross-sectional. Studies more often examined general leadership rather than leadership strategically focused on EBP implementation (i.e., strategic implementation leadership). Our findings suggest that several forms of first-level leadership are inconsistently related to a broad set of implementation determinants, with infrequent examination of specific implementation outcomes. The broad set of implementation determinants studied, limited number of replications, and inconsistent findings have resulted in sparse evidence for any specific leadership-outcome relationship. The greatest accumulation of evidence exists for general leadership's positive relationship with providers' EBP attitudes, most notably in the form of transformational leadership. This was followed by evidence for strategic implementation leadership facilitating general implementation. Our synthesis revealed moderate conceptual overlap of strategic implementation leadership behaviors described in the theory of implementation leadership and theory of middle managers' role in implementation. CONCLUSIONS Our findings suggest that first-level leadership may play an important role in shaping implementation determinants and outcomes, but consistent empirical support is sparse and confidence dampened by methodological issues. To advance the field, we need studies that adopt stronger methodological rigor, address the conceptual overlap in leadership frameworks, examine a broader set of implementation outcomes, and examine conditions under which leadership impacts implementation. TRIAL REGISTRATION This review was not registered.
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Affiliation(s)
- Rosemary D. Meza
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Noah S. Triplett
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Grace S. Woodard
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Prerna Martin
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Alya N. Khairuzzaman
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Gabrielle Jamora
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
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Ramos G, Brookman-Frazee L, Kodish T, Rodriguez A, Lau AS. Community providers' experiences with evidence-based practices: The role of therapist race/ethnicity. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2021; 27:471-482. [PMID: 32391705 PMCID: PMC7655698 DOI: 10.1037/cdp0000357] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Examining therapists' experiences implementing evidence-based practices (EBPs) is fundamental to understanding how these interventions are perceived, adapted, and delivered in community settings. However, little is known about racial/ethnic variation in the experiences of therapists serving racial/ethnic minority youth and their families. Through an innovative QUAN → qual → QUAN mixed-methods approach, we examined differences in therapists' perceptions, adaptations performed, and client-engagement challenges in the largest county-operated department of mental health in the United States. METHOD Surveys were completed by 743 therapists (Latinx [44%], White [34%], other ethnic minority [22%]), most of whom were female (88%), master's level (85%), and unlicensed (58%). A subset of therapists (n = 60) completed semistructured interviews. RESULTS Latinx therapists reported more positive experiences implementing EBPs, making more adaptations to EBPs, and encountering fewer client-engagement challenges than therapists from other racial/ethnic groups. Qualitative analyses expanded on these results, revealing that Latinx therapists commonly described adapting EBPs in terms of language and culture to improve fit and promote client engagement. Informed by these qualitative themes, a refined statistical model revealed that the ability to deliver EBPs in languages other than English might have accounted for differences in therapist-reported EBP adaptations and client-engagement challenges. CONCLUSIONS The findings suggest that racial/ethnic minority therapists have positive experiences in implementing EBPs in community settings. In the case of Latinx therapists, bilingual/bicultural competence may facilitate adapting EBPs in ways that reduce perceptions of engagement challenges with racially/ethnically diverse clients. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Giovanni Ramos
- Department of Psychology, University of California, Los Angeles
| | - Lauren Brookman-Frazee
- Department of Psychiatry, Child and Adolescent Services Research Center, University of California, San Diego
| | - Tamar Kodish
- Department of Psychology, University of California, Los Angeles
| | - Adriana Rodriguez
- Children and Youth Behavioral Health, Health Care Agency, Orange County
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles
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Gomez E, Drahota A, Stahmer AC. Choosing strategies that work from the start: A mixed methods study to understand effective development of community-academic partnerships. ACTION RESEARCH (LONDON) 2021; 19:277-300. [PMID: 34539247 PMCID: PMC8447887 DOI: 10.1177/1476750318775796] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Community-academic partnerships are believed to increase the effectiveness and feasibility of action research. While factors facilitating and hindering community-academic partnerships have been identified, their influence on the collaborative process is unknown, especially during community-academic partnership initiation and development. This explanatory sequential mixed methods study (quantitative→QUALITATIVE) evaluated perspectives of members in an autism community-academic partnership to determine frequently endorsed and influential factors facilitating and hindering the collaborative process during the community-academic partnership's development. Participants (n = 11; community stakeholders, implementation scientist, and researchers) endorsed and ranked the importance of factors present in the formation of the community-academic partnership then completed a semi-structured qualitative interview to elaborate on survey responses. Interviews were coded using a coding, comparison, and consensus method and analyzed using the Rapid Assessment Process for frequency and salience of themes across interviews. Integrating mixed methods yielded ranked factors that were perceived to facilitate and hinder the development of the community-academic partnership, and highlighted the relative influence of interpersonal factors on the facilitation of community-academic partnership processes and organizational factors on the hindrance of community-academic partnership processes during development. Some discrepancies emerged between community and academic partners. Results may assist to improve the development of community-academic partnerships, which is becoming increasingly important in healthcare services research, dissemination, and implementation.
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Affiliation(s)
- Emily Gomez
- Department of Psychology, Child and Adolescent Services Research Center, San Diego, USA
| | - Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, USA; Child and Adolescent Services Research Center, San Diego, USA
| | - Aubyn C Stahmer
- Department of Psychiatry and Behavioral Health, UC Davis MIND Institute, University of California, Sacramento, USA; Child and Adolescent Services Research Center, San Diego, USA
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Knowledge of Evidence-Based Services Questionnaire: Development and Validation of a Short Form. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:581-596. [PMID: 32076887 DOI: 10.1007/s10488-020-01020-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Knowledge of Evidence-Based Services Questionnaire (KEBSQ) is an objective measure of therapist knowledge of practices derived from the evidence base for the treatment of youth psychopathology. However, the length of this measure (i.e., 40 items) and respondent demands associated with each item makes it burdensome for researchers and clinicians. This study developed and validated a Short Form of the KEBSQ using Item Response Theory measurement models. The Short Form consists of 17 items and generates two separate scores: Correct Endorsements and Correct Rejections. The Short Form was found to correlate highly with and perform similarly to the Full Form, providing preliminary validity evidence.
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Abstract
This study examined the psychometric properties of the Intention Scale for Providers-Direct Items (ISP-D; 16 items), a questionnaire for assessing therapists' evidence-based practice attitudes, subjective norms, perceived behavioral control, and behavioral intentions. Participants were community mental health providers from the State of Hawaii. A confirmatory factor analysis provided support for a revised 14-item ISP-D measure that fits the data reasonably well. Subscales of this revised ISP-D demonstrated acceptable to good internal consistency, with the exception of the Perceived Behavioral Control subscale. The majority of convergent validity correlation patterns between the ISP-D and related constructs were significant and in predicted directions.
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Creed TA, Crane ME, Calloway A, Olino TM, Kendall PC, Stirman SW. Changes in Community Clinicians' Attitudes and Competence following a Transdiagnostic Cognitive Behavioral Therapy Training. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 34541540 PMCID: PMC8444627 DOI: 10.1177/26334895211030220] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Although the literature suggest that attitudes toward evidence-based practices (EBPs) are associated with provider use of EBPs, less is known about the association between attitudes and how competently EBPs are delivered. This study examined how initial attitudes and competence relate to improvements in attitudes and competence following EBP training. Methods Program evaluation data was collected during implementation of an EBP in a large community mental health network. Clinicians (N=891) received intensive training in cognitive behavioral therapy followed by six months of consultation. Attitudes were assessed using the Evidence-Based Practice Attitude Scale, and competence was assessed using the Cognitive Therapy Rating Scale. Data were analyzed by fitting three latent change score models to examine the relationship between changes in attitudes and competence across the training and within its two phases (workshop phase, consultation phase). Results Latent change models identified significant improvement in attitudes (Ms latent change≥1.03, SEs≤ 0.18, zs≥6.55, ps< .001) and competence (Ms latent change ≥14.16, SEs≤3.10, zs≥2.82, ps<.001) across the full training and in each phase. Higher pre-workshop attitudes predicted significantly greater change in competence in the workshop and across training (bs≥1.62, SEs≤0.90, z≥1.09, p<.04, β≥0.10); however, contrary to our hypothesis, post-workshop attitudes did not significantly predict change in competence in consultation (b=1.62, SE=0.86, z=1.87, p=.06, β=0.09). Change in attitudes and change in competence in the training period and within the two phases were not significantly correlated. Conclusions Results indicate that pre-training attitudes about EBPs present a target for implementation interventions, given their relation to changes in both attitudes and competence throughout training. Following participation in in itial training workshops, other factors such as subjective norms, implementation culture, or system-level policy shifts may be more predictive of change in competence through consultation.
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Affiliation(s)
- Torrey A Creed
- Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Suite 3046, Philadelphia, PA, USA
| | - Margaret E Crane
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, USA
| | - Amber Calloway
- Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Suite 3046, Philadelphia, PA, USA
| | - Thomas M Olino
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, USA
| | - Shannon Wiltsey Stirman
- National Center for PTSD and Stanford University, 795 Willow Road NC-PTSD, Menlo Park, CA, 94025, USA
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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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Santesson AHE, Bäckström M, Holmberg R, Perrin S, Jarbin H. Confirmatory factor analysis of the Evidence-Based Practice Attitude Scale (EBPAS) in a large and representative Swedish sample: is the use of the total scale and subscale scores justified? BMC Med Res Methodol 2020; 20:254. [PMID: 33054717 PMCID: PMC7557010 DOI: 10.1186/s12874-020-01126-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/18/2020] [Indexed: 11/24/2022] Open
Abstract
Background There is a call for valid and reliable instruments to evaluate implementation of evidence-based practices (EBP). The 15-item Evidence-Based Practice Attitude Scale (EBPAS) measures attitude toward EBP, incorporating four lower-order factor subscales (Appeal, Requirements, Openness, and Divergence) and a Total scale (General Attitudes). It is one of a few measures of EBP attitudes evaluated for its psychometric properties. The reliability of the Total scale has been repeatedly supported, but also the multidimensionality of the inventory. However, whether all of the items contribute to the EBPAS Total beyond their subscales has yet to be demonstrated. In addition, the Divergence subscale has been questioned because of its low correlation with the other subscales and low inter-item correlations. The EBPAS is widely used to tailor and evaluate implementation efforts, but a Swedish version has not yet been validated. This study aimed to contribute to the development and cross-validation of the EBPAS by examining the factor structure of t a Swedish-language version in a large sample of mental health professionals. Methods The EBPAS was translated into Swedish and completed by 570 mental health professionals working in child and adolescent psychiatry settings spread across Sweden. The factor structure was examined using first-order, second-order and bifactor confirmatory factor analytic (CFA) models. Results Results suggested adequate fit for all CFA models. The EBPAS Total was strongly supported in the Swedish version. Support for the hierarchical second-order model was also strong, while the bifactor model gave mixed support for the subscales. The Openness and Requirements subscales came out best, while there were problems with both the Appeal (e.g. not different from the General Attitudes factor) and the Divergence subscales (e.g. low reliability). Conclusions Overall, the psychometric properties were on par with the English version and the total score appears to be a valid measure of general attitudes towards EBP. This is the first study supporting this General Attitudes factor based on a bifactor model. Although comparatively better supported in this Swedish sample, we conclude that the use of the EBPAS subscale scores may result in misleading conclusions. Practical implications and future directions are discussed.
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Affiliation(s)
| | - Martin Bäckström
- Department of Psychology, Faculty of Social Sciences, Lund University, Lund, Sweden
| | - Robert Holmberg
- Department of Psychology, Faculty of Social Sciences, Lund University, Lund, Sweden
| | - Sean Perrin
- Department of Psychology, Faculty of Social Sciences, Lund University, Lund, Sweden
| | - Håkan Jarbin
- Department of Clinical Sciences, Faculty of Medicine, Lund University, BMC F12, S-, 221 84, Lund, Sweden
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Okamura KH, Jackson DS, Nakamura BJ. Therapist and Youth Predictors of Specific Practices Derived from the Evidence-Base in Community Mental Health. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:609-619. [PMID: 31152274 DOI: 10.1007/s10488-019-00942-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Over the past several years, youth treatment research has moved toward understanding the dissemination and implementation of evidence-based practices (EBPs). As a result, studies have focused on identifying predictors that aid in successful adoption and sustainment of EBPs. Theories of behavior change posit that therapist knowledge and attitudes play a fundamental role in EBP adoption; however, studies have produced mixed findings, which may be an artifact of broad definitions of both EBP knowledge and EBP itself. The current study was an examination of 46 youth community therapists and the extent to which varying types of knowledge and attitudes as well as youth characteristics predicted specific practices derived from the evidence-base. Results suggested that specific EBP knowledge predicted specific practices, highlighting the need for more specificity when examining predictors of EBP use. Therapists' attitudes, demographic characteristics, and youth characteristics were also significant predictors of EBP use. Future research should consider examining discrete and specific practices to better understand and predict therapists' future behavior.
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Affiliation(s)
- Kelsie H Okamura
- University of Hawai'i at Mānoa, Honolulu, HI, USA. .,State of Hawai'i Child and Adolescent Mental Health Division, Honolulu, USA.
| | - David S Jackson
- State of Hawai'i Child and Adolescent Mental Health Division, Honolulu, USA
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Haine-Schlagel R, Rieth S, Dickson KS, Brookman-Frazee L, Stahmer A. Adapting parent engagement strategies for an evidence-based parent-mediated intervention for young children at risk for autism spectrum disorder. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:1215-1237. [PMID: 32237157 DOI: 10.1002/jcop.22347] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 01/31/2020] [Accepted: 03/11/2020] [Indexed: 06/11/2023]
Abstract
AIMS Aims included (a) characterizing provider feedback on parent engagement strategies integrated into a parent-mediated intervention for toddlers at risk for autism spectrum disorder (ASD) and (b) identifying provider characteristics that predict attitudes about parent engagement strategies. METHODS A mixed method approach was utilized, including gathering quantitative data via survey (breadth) and collecting qualitative data via interview (depth). Acceptability, utility, appropriateness, sustainment, generalizability, and perceived effectiveness were examined. Fourteen agency leaders and 24 therapists provided input. RESULTS Providers perceived the integration of parent engagement strategies as having a positive impact on implementation. Providers considered the strategies to be acceptable, appropriate, and effective, though barriers of time and complexity were noted. Provider characteristics did not consistently predict attitudes about the engagement strategies. CONCLUSIONS Incorporating parent engagement strategies into parent-mediated interventions for ASD is well-received by providers and may improve quality of service delivery for families served in early intervention for ASD.
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Affiliation(s)
- Rachel Haine-Schlagel
- Department of Child and Family Development, San Diego State University, San Diego, California
- Child & Adolescent Services Research Center, San Diego, California
| | - Sarah Rieth
- Department of Child and Family Development, San Diego State University, San Diego, California
- Child & Adolescent Services Research Center, San Diego, California
| | - Kelsey S Dickson
- Department of Child and Family Development, San Diego State University, San Diego, California
- Child & Adolescent Services Research Center, San Diego, California
| | - Lauren Brookman-Frazee
- Child & Adolescent Services Research Center, San Diego, California
- Department of Psychiatry, University of California, San Diego, California
| | - Aubyn Stahmer
- Child & Adolescent Services Research Center, San Diego, California
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California
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O'Dell SM, Hosterman SJ, Hostutler CA, Nordberg C, Klinger T, Petts RA, Whitehead MR, Faulkner SA, Garcia A, Massura CA. Retrospective cohort study of a novel acceptance and commitment therapy group intervention for adolescents implemented in integrated primary care. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Factors Associated with Community-Partnered School Behavioral Health Clinicians' Adoption and Implementation of Evidence-Based Practices. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:91-104. [PMID: 30244430 DOI: 10.1007/s10488-018-0897-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Community-partnered school behavioral health (CP-SBH) is a model whereby schools partner with local community agencies to deliver services. This mixed-methods study examined 80 CP-SBH clinicians' adoption and implementation of evidence-based practice (EBP) approaches following mandated training. Forty-four clinicians were randomly assigned to one of two training conditions for a modular common elements approach to EBPs; 36 clinicians were preselected for training in a non-modular EBP. EBP knowledge improved for all training conditions at 8-month follow-up and practice element familiarity improved for modular approach training conditions, but the modular condition including ongoing consultation did not yield better results. Qualitative interviews (N = 17) highlighted multi-level influences of the CP-SBH service system and individual clinician characteristics on adoption and implementation.
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Multilevel Predictors of Case Managers' Assessment Administration Behavior in a Precursor to a Measurement Feedback System. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 46:636-648. [PMID: 31123867 DOI: 10.1007/s10488-019-00941-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examines factors associated with administration of a treatment monitoring assessment measure (the Ohio Scales) in the context of a precursor to a measurement feedback system in a youth public mental health setting. 82% of all state case managers (N = 46) completed interviews and administered at least one Ohio Scale over a 12-month period. A multi-level model accounting for variance between both case managers and their administrative offices indicated that case manager characteristics (lower self-reported burnout, more experience) and monthly caseload characteristics (fewer active cases, younger average age of youth, and increased time since initial administration) predicted increased monthly administration proportions.
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Higa-McMillan CK, Ebesutani C, Stanick CF. What Therapy Practices Do Providers Value in Youth Behavioral Health? A Measure Development Study. J Behav Health Serv Res 2019; 46:607-624. [PMID: 31037479 DOI: 10.1007/s11414-019-09651-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Existing measures of attitudes toward evidence-based practices (EBPs) assess attitudes toward manualized or research-based treatments. Providers of youth behavioral health (N = 282) completed the Valued Practices Inventory (VPI), a new measure of provider attitudes toward specific practices for youth that avoids mention of EBPs by listing specific therapies-some of which are drawn from EBPs (e.g., problem solving) and some of which are not included in EBPs (e.g., dream interpretation). Exploratory factor analysis revealed two factors: practices derived from the evidence base (PDEB) and alternative techniques (AT). The PDEB scale was significantly correlated with scales on the Evidence-Based Practice Attitude Scale-50 (Aarons et al. in Administration and Policy in Mental Health and Mental Health Services Research, 39(5): 331-340, 2012), whereas the AT scale was not. Attitudes toward PDEB and AT were also related to provider characteristics such as years of experience and work setting. The VPI offers a complementary approach to existing measures of attitudes because it avoids mention of EBPs, which may help prevent biases in responses.
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Affiliation(s)
| | | | - Cameo F Stanick
- Hathaway-Sycamores Child and Family Services, Pasadena, CA, USA
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A History of Child and Adolescent Treatment Through a Distillation Lens: Looking Back to Move Forward. J Behav Health Serv Res 2019; 47:70-85. [DOI: 10.1007/s11414-019-09659-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Walker SC, Sedlar G, Berliner L, Rodriguez FI, Davis PA, Johnson S, Leith J. Advancing the state-level tracking of evidence-based practices: a case study. Int J Ment Health Syst 2019; 13:25. [PMID: 31007712 PMCID: PMC6457070 DOI: 10.1186/s13033-019-0280-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/25/2019] [Indexed: 01/21/2023] Open
Abstract
Background Despite a sustained focus by policymakers and researchers on improving the standard of clinical care in public mental health services, the use of evidence-based practice remains low. Among other challenges, this reflects the difficulty of translating clinical research into useable policy that can be feasibly funded and monitored by state or large healthcare systems. Case presentation In this paper we present a case study of Washington State’s strategy for monitoring the use of clinical elements at the session level for all Medicaid-funded children’s mental health services. The implementation of this strategy reflects policy actions to promote effective practice while also actively influencing multiple other levels of the implementation ecology. The approach is informed by the Policy Ecology Framework, the Consolidated Framework for Implementation Research, the evidence-based policymaking literature, and common ontology and clinical elements models. Conclusions We found the strategy developed in Washington State to be a feasible method of collecting session level information about the use of effective clinical mental health practices. In addition, the approach appears to be having influence on multiple layers of the implementation ecology that could be explored through further study.
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Affiliation(s)
- Sarah Cusworth Walker
- 1Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE Campus Parkway, Box 358015, Seattle, WA 98105 USA
| | - Georganna Sedlar
- 1Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE Campus Parkway, Box 358015, Seattle, WA 98105 USA
| | - Lucy Berliner
- Harborview Center for Sexual Assault and Trauma, 401 Broadway, Seattle, WA 98104 USA
| | - Felix I Rodriguez
- Washington State Health Care Authority, 626 8th Ave SE, Olympia, WA 98501 USA
| | - Paul A Davis
- Washington State Health Care Authority, 626 8th Ave SE, Olympia, WA 98501 USA
| | - Savannah Johnson
- 4Duke University, 2127 Campus Drive, Box 90065, Durham, NC 27708 USA
| | - Jessica Leith
- 1Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE Campus Parkway, Box 358015, Seattle, WA 98105 USA
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Williams N, Beidas R. Annual Research Review: The state of implementation science in child psychology and psychiatry: a review and suggestions to advance the field. J Child Psychol Psychiatry 2019; 60:430-450. [PMID: 30144077 PMCID: PMC6389440 DOI: 10.1111/jcpp.12960] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Scientists have developed evidence-based interventions that improve the symptoms and functioning of youth with psychiatric disorders; however, these interventions are rarely used in community settings. Eliminating this research-to-practice gap is the purview of implementation science, the discipline devoted to the study of methods to promote the use of evidence-based practices in routine care. METHODS We review studies that have tested factors associated with implementation in child psychology and psychiatry, explore applications of social science theories to implementation, and conclude with recommendations to advance implementation science through the development and testing of novel, multilevel, causal theories. RESULTS During its brief history, implementation science in child psychology and psychiatry has documented the implementation gap in routine care, tested training approaches and found them to be insufficient for behavior change, explored the relationships between variables and implementation outcomes, and initiated randomized controlled trials to test implementation strategies. This research has identified targets related to implementation (e.g., clinician motivation, organizational culture) and demonstrated the feasibility of activating these targets through implementation strategies. However, the dominant methodological approach has been atheoretical and predictive, relying heavily on a set of variables from heuristic frameworks. CONCLUSIONS Optimizing the implementation of effective treatments in community care for youth with psychiatric disorders is a defining challenge of our time. This review proposes a new direction focused on developing and testing integrated causal theories. We recommend implementation scientists: (a) move from observational studies of implementation barriers and facilitators to trials that include causal theory; (b) identify a core set of implementation determinants; (c) conduct trials of implementation strategies with clear targets, mechanisms, and outcomes; (d) ensure that behaviors that are core to EBPs are clearly defined; and (e) agree upon standard measures. This agenda will help fulfill the promise of evidence-based practice for improving youth behavioral health.
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Affiliation(s)
| | - Rinad Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
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Danielson M, Månsdotter A, Fransson E, Dalsgaard S, Larsson JO. Clinicians' attitudes toward standardized assessment and diagnosis within child and adolescent psychiatry. Child Adolesc Psychiatry Ment Health 2019; 13:9. [PMID: 30792803 PMCID: PMC6371426 DOI: 10.1186/s13034-019-0269-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 01/31/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is a strong call for clinically useful standardized assessment tools in everyday child and adolescent psychiatric practice. The attitudes of clinicians have been raised as a key-facilitating factor when implementing new methods. An explorative study was conducted aimed to investigate the clinicians' attitudes regarding standardized assessments and usefulness of diagnoses in treatment planning. METHODS 411 mental health service personnel working with outpatient and inpatient assessment and treatment within the specialist child and adolescent mental health services, Stockholm County Council were asked to participate in the study, of which 345 (84%) agreed answer a questionnaire. The questionnaire included questions regarding Attitudes toward Standardized Assessment and Utility of Diagnosis. Descriptive analyses were performed and four subscales were compared with information from a similar study in US using the same instruments. The demographic and professional characteristics (age, working years, gender, education, profession, management position, involvement in assessment, level of service) in terms of prediction of attitudes were studied by univariate and multivariate linear regressions. RESULTS Overall, the clinicians had quite positive attitudes and were more positive compared to a similar study conducted in the US earlier. There were differences in attitudes due to several characteristics but the only characteristic predicting all subscales was type of profession (counselor, nurse, psychiatrist, psychologist, other), with counselors being less positive than other groups. CONCLUSION The overall positive attitudes toward standard assessment are of importance in the development of evidence-based practice and our study implies that clinicians in general value and are willing to use standardized assessment. Nevertheless, there are specific issues such as adequate training and available translated assessment instrument that need to be addressed. When implementing new methods in practice, there are general as well as specific resistances that need to be overcome. Studies in different cultural settings are of importance to further extend the knowledge of what is general and what is specific barriers.
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Affiliation(s)
- M. Danielson
- 0000 0004 1937 0626grid.4714.6Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden ,0000 0001 2326 2191grid.425979.4Stockholm Child and Adolescent Psychiatry, Stockholm County Council, Box 17914, 118 95 Stockholm, Sweden
| | - A. Månsdotter
- 0000 0004 0623 991Xgrid.412215.1Department of Public Health and Clinical Medicine, 901 87 Umeå, Sweden
| | - E. Fransson
- 0000 0004 1936 9377grid.10548.38Centre for Health Equity Studies, Department of Public Health Sciences, Stockholm University, 106 91 Stockholm, Sweden ,0000 0004 1937 0626grid.4714.6Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - S. Dalsgaard
- 0000 0001 1956 2722grid.7048.bThe National Centre for Register-based Research (NCRR) and Centre for Integrated Register-based Research at AU (CIRRAU), Aarhus University, Fuglesangs Alle 4, 8210 Aarhus V, Denmark
| | - J-O. Larsson
- 0000 0004 1937 0626grid.4714.6Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden ,0000 0001 2326 2191grid.425979.4Stockholm Child and Adolescent Psychiatry, Stockholm County Council, Box 17914, 118 95 Stockholm, Sweden
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Gellatly R, Brookman-Frazee L, Barnett M, Gonzalez JC, Kim JJ, Lau AS. Therapist Reports of EBP Client Engagement Challenges in Sessions with Diverse Youth and Families in Community Mental Health Settings. CHILD & YOUTH CARE FORUM 2019; 48:55-75. [PMID: 32132809 PMCID: PMC7055736 DOI: 10.1007/s10566-018-9472-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The implementation of evidence-based practices (EBPs) in community settings appears to result in reduced benefit relative to controlled trials. This difference in outcomes may be attributable in part to engagement challenges therapists encounter when delivering EBPs to low-income ethnic minority youth and families. OBJECTIVE The current study sought to identify therapist, client, and session characteristics associated with therapist-reported engagement challenges in therapy sessions, as well the associations between two types of client engagement challenges and therapists' self-reported ability to deliver the EBP in sessions within a system-driven implementation in public children's mental health services. METHOD One hundred and three therapists reported on two types of engagement challenges-Limited Client Engagement and Expressed Client Concerns-in 702 sessions with 274 clients. RESULTS Results indicated that therapists reported a higher frequency of Limited Client Engagement in sessions with male clients and in sessions where the youth was present, and by therapists with smaller caseloads. No variables significantly predicted Expressed Client Concerns. Both types of engagement challenges were negatively associated with therapists' report of their ability to carry out intended activities in the same session. CONCLUSIONS Findings suggest that therapists may benefit from learning strategies to address these two distinct types of engagement challenges encountered in implementation of EBPs with diverse families in community settings.
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Affiliation(s)
- R. Gellatly
- University of California, Los Angeles, Los Angeles, CA, USA
| | - L. Brookman-Frazee
- University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - M. Barnett
- University of California, Santa Barbara, Santa Barbara, CA, USA
| | - J. C. Gonzalez
- University of California, Santa Barbara, Santa Barbara, CA, USA
| | - J. J. Kim
- University of California, Los Angeles, Los Angeles, CA, USA
| | - A. S. Lau
- University of California, Los Angeles, Los Angeles, CA, USA
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Asnaani A, Gallagher T, Foa EB. Evidence‐based protocols: Merits, drawbacks, and potential solutions. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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33
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Vona P, Baweja S, Santiago CD, Pears G, Langley A, Kataoka S. A Cross-Site Partnership to Examine Implementation and Sustainability of a School-Based Trauma Program. Ethn Dis 2018; 28:427-436. [PMID: 30202196 DOI: 10.18865/ed.28.s2.427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives Schools have been identified as an ideal setting for increasing access to mental health services particularly for underserved minority youth. The emerging field of implementation science has begun to systematically investigate strategies for more efficiently integrating evidence-based practices into community settings. Significantly less translational research has focused specifically on the school setting. To address this need, we examined the implementation of a school-based trauma intervention across three distinct regions. Design We conducted key informant interviews guided by Mendel's Framework of Dissemination in Health Services Intervention Research with multiple school stakeholders to examine what school organizational characteristics influence the adoption and implementation process and sustainability of Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Participants were selected from schools in three geographic regions in the United States: Western, Midwestern, and Southern. Results Our findings reveal that while sites had some common organizational factors that appeared to facilitate implementation, regions differed in how they compensated for less robust implementation domains. Across all regions, school stakeholders recognized the need for services to support students impacted by trauma. In the Western region, there was no centralized district policy for implementation; therefore, implementation was facilitated by school-level change agents and supervision support from the district mental health unit. In the Midwestern region, centralized district policies drove implementation. In both the Midwestern and Southern regions, implementation was facilitated by collaboration with a local mental health agency. Conclusions This study contributes to the paucity of empirical information on the organizational factors that influence the implementation of evidence-based mental health interventions in schools. Our findings reveal that different implementation strategies across policies, structures, and resources can result in implementation of a school-based intervention. Frameworks such as Mendel's can be helpful in identifying areas of strength and improvement of implementation within a school organization.
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Affiliation(s)
- Pamela Vona
- Suzanne Dworak-Peck School of Social Work, University of Southern California; Los Angeles, CA
| | - Shilpa Baweja
- Department of Education and Information Studies, University of California, Los Angeles; Los Angeles, CA
| | | | - Gillian Pears
- UCLA Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society; University of California, Los Angeles, Los Angeles, CA
| | - Audra Langley
- UCLA Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society; University of California, Los Angeles, Los Angeles, CA
| | - Sheryl Kataoka
- UCLA Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society; University of California, Los Angeles, Los Angeles, CA
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Man J, Kangas M. Service satisfaction and helpfulness ratings, mental health literacy and help seeking barriers of carers of individuals with dual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:184-193. [DOI: 10.1111/jar.12520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/24/2018] [Accepted: 07/25/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Joyce Man
- Department of Psychology Centre for Emotional Health Macquarie University North Ryde New South Wales Australia
| | - Maria Kangas
- Department of Psychology Centre for Emotional Health Macquarie University North Ryde New South Wales Australia
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Barnett M, Brookman-Frazee L, Regan J, Saifan D, Stadnick N, Lau A. How Intervention and Implementation Characteristics Relate to Community Therapists' Attitudes Toward Evidence-Based Practices: A Mixed Methods Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:824-837. [PMID: 28236076 DOI: 10.1007/s10488-017-0795-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Therapists' perceptions toward evidence-based practices (EBPs) are important in implementation efforts, however little is known about characteristics of EBPs associated with more positive attitudes. This mixed-methods study examined how intervention and implementation characteristics of six EBPs related to therapist attitudes. Quantitative analysis of 793 cross-sectional surveys revealed that therapists endorsed more positive attitudes toward EBPs with (1) prescribed session content and order and (2) required consultation. Associations between these intervention and implementation characteristics and attitudes were not moderated by therapist experience or emotional exhaustion. Qualitative analyses complemented quantitative findings, indicating that "structure" was appealing for interventions and that therapists felt supported by consultation.
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Affiliation(s)
- Miya Barnett
- Department of Counseling, Clinical, & School Psychology, Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA.
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.,Child and Adolescents Service Research Center, San Diego, CA, USA
| | - Jennifer Regan
- Hathaway-Sycamores, Child and Family Services, Pasadena, CA, USA
| | - Dana Saifan
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nicole Stadnick
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.,Child and Adolescents Service Research Center, San Diego, CA, USA
| | - Anna Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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Therapist Attitudes Towards Evidence-Based Practice: A Joint Factor Analysis. J Behav Health Serv Res 2018; 44:414-427. [PMID: 27230350 DOI: 10.1007/s11414-016-9517-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Despite the accumulated research support for the use of evidence-based practices (EBPs) with youth, these treatment approaches remain underutilized in community settings. Therapist attitudes towards EBPs play a pivotal role in their adoption and implementation of these practices. The present investigation employs joint exploratory factor analysis to evaluate the structure of two measures of therapist attitudes, the Evidence-Based Practices Attitudes Scale and the Modified Practice Attitude Scale. Results suggest three factors including (a) importance of clinical experience over EBPs, (b) clinician openness to change, and (c) problems with EBPs. Recommendations are provided for future evaluation of therapist attitudes and associated characteristics.
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Trask EV, Barounis K, Carlisle BL, Garland AF, Aarons GA. Factors Associated with Assignment of Therapeutic Homework in a Large Public Children's Mental Health System. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:821-830. [PMID: 29574542 DOI: 10.1007/s10488-018-0867-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Therapeutic homework is a fundamental skill-building component of the majority of evidence-based therapies and is associated with better treatment outcomes. However, it is rarely utilized in public mental health settings. To determine barriers to homework use and identify predictors of clinicians' assignment of homework, an online survey was administered to 267 clinicians in a large diverse public mental health system. Clinicians who were younger, licensed, whose supervisors asked about homework and whose clients completed their homework more frequently were predictors of greater homework utilization. The survey results are discussed and a novel idea to increase the use of homework is introduced.
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Affiliation(s)
- Emily Velazquez Trask
- Department of Psychiatry, University of California, San Diego, 3665 Kearny Villa Rd. Ste 200, San Diego, CA, 92123, USA.
| | - Kya Barounis
- Department of Psychiatry, University of California, San Diego, 3665 Kearny Villa Rd. Ste 200, San Diego, CA, 92123, USA
| | - Brandon L Carlisle
- Department of Psychiatry, University of California, San Diego, 3665 Kearny Villa Rd. Ste 200, San Diego, CA, 92123, USA
| | - Ann F Garland
- Department of Counseling & Marital and Family Therapy, University of San Diego, San Diego, CA, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, 3665 Kearny Villa Rd. Ste 200, San Diego, CA, 92123, USA
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38
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Knowledge, Attitudes, Social Desirability, and Organizational Characteristics in Youth Mental Health Services. J Behav Health Serv Res 2018; 43:630-647. [PMID: 26645291 DOI: 10.1007/s11414-015-9491-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This project investigated the extent to which knowledge of evidence-based practices (EBPs) and organizational characteristics predicted attitudes toward EBPs, while controlling for social desirability and organization membership. Participants were 167 public sector youth practitioners. Hierarchical multiple regression analyses were conducted to determine which factors significantly predicted EBP attitudes. Findings suggested that social desirability, organization membership, and various organizational characteristics predicted EBP attitudes. Results are discussed as they relate to the importance of including social desirability in future research and identifying different factors that influence EBP attitudes across various organizations.
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39
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Furthering Our Understanding of Therapist Knowledge and Attitudinal Measurement in Youth Community Mental Health. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:699-708. [DOI: 10.1007/s10488-018-0854-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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40
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Facilitators and Barriers of Implementing a Measurement Feedback System in Public Youth Mental Health. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:861-878. [PMID: 27000148 DOI: 10.1007/s10488-016-0729-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examines implementation facilitators and barriers of a statewide roll-out of a measurement feedback system (MFS) in a youth public mental health system. 76 % of all state care coordinators (N = 47) completed interviews, which were coded via content analysis until saturation. Facilitators (e.g., recognition of the MFS's clinical utility) and barriers (e.g., MFS's reliability and validity) emerged paralleling the Exploration, Adoption/Preparation, Implementation, and Sustainment framework outlined by Aarons et al. (Adm Policy Mental Health Mental Health Serv Res, 38:4-23, 2011). Sustainment efforts may leverage innovation fit, individual adopter, and system related facilitators.
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41
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Beidas R, Skriner L, Adams D, Wolk CB, Stewart RE, Becker-Haimes E, Williams N, Maddox B, Rubin R, Weaver S, Evans A, Mandell D, Marcus SC. The relationship between consumer, clinician, and organizational characteristics and use of evidence-based and non-evidence-based therapy strategies in a public mental health system. Behav Res Ther 2017; 99:1-10. [PMID: 28865284 DOI: 10.1016/j.brat.2017.08.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/15/2017] [Accepted: 08/21/2017] [Indexed: 11/30/2022]
Abstract
We investigated the relationship between consumer, clinician, and organizational factors and clinician use of therapy strategies within a system-wide effort to increase the use of cognitive-behavioral therapy. Data from 247 clinicians in 28 child-serving organizations were collected. Clinicians participating in evidence-based practice training initiatives were more likely to report using cognitive-behavioral therapy when they endorsed more clinical experience, being salaried clinicians, and more openness to evidence-based practice. Clinicians participating in evidence-based practice initiatives were more likely to use psychodynamic techniques when they had older clients, less knowledge about evidence-based practice, more divergent attitudes toward EBP, higher financial strain, and worked in larger organizations. In clinicians not participating in evidence-based training initiatives; depersonalization was associated with higher use of cognitive-behavioral; whereas clinicians with less knowledge of evidence-based practices were more likely to use psychodynamic techniques. This study suggests that clinician characteristics are important when implementing evidence-based practices; and that consumer, clinician, and organizational characteristics are important when de-implementing non evidence-based practices. This work posits potential characteristics at multiple levels to target with implementation and deimplementation strategies.
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Affiliation(s)
- Rinad Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA.
| | - Laura Skriner
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA; Department of Psychiatry, Weill Cornell Medicine, New York-Presbyterian Hospital, 21 Bloomingdale Road, White Plains, NY 10605, USA.
| | - Danielle Adams
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA; School of Social Service Administration, The University of Chicago, 969 East 60th Street, Chicago, IL 60637, USA.
| | - Courtney Benjamin Wolk
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA.
| | - Rebecca E Stewart
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA.
| | - Emily Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA.
| | - Nathaniel Williams
- School of Social Work, Boise State University, 1910 University Drive, Boise, ID 83642, USA.
| | - Brenna Maddox
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA.
| | - Ronnie Rubin
- Department of Behavioral Health and Intellectual DisAbility Services, 801 Market St #7000, Philadelphia, PA 19107, USA.
| | - Shawna Weaver
- Department of Behavioral Health and Intellectual DisAbility Services, 801 Market St #7000, Philadelphia, PA 19107, USA.
| | - Arthur Evans
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA; Department of Behavioral Health and Intellectual DisAbility Services, 801 Market St #7000, Philadelphia, PA 19107, USA.
| | - David Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA.
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, USA.
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Bearman SK, Schneiderman RL, Zoloth E. Building an Evidence Base for Effective Supervision Practices: An Analogue Experiment of Supervision to Increase EBT Fidelity. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 44:293-307. [PMID: 26867545 PMCID: PMC6656533 DOI: 10.1007/s10488-016-0723-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Treatments that are efficacious in research trials perform less well under routine conditions; differences in supervision may be one contributing factor. This study compared the effect of supervision using active learning techniques (e.g. role play, corrective feedback) versus "supervision as usual" on therapist cognitive restructuring fidelity, overall CBT competence, and CBT expertise. Forty therapist trainees attended a training workshop and were randomized to supervision condition. Outcomes were assessed using behavioral rehearsals pre- and immediately post-training, and after three supervision meetings. EBT knowledge, attitudes, and fidelity improved for all participants post-training, but only the SUP+ group demonstrated improvement following supervision.
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Affiliation(s)
- Sarah Kate Bearman
- Department of Educational Psychology, The University of Texas at Austin, 504 SZB, 1 University Station, D5800, Austin, TX, 78712-0383, USA.
| | - Robyn L Schneiderman
- Ferkauf Graduate School of Psychology, Department of School-Clinical Child Psychology, Yeshiva University, New York, USA
| | - Emma Zoloth
- Ferkauf Graduate School of Psychology, Department of School-Clinical Child Psychology, Yeshiva University, New York, USA
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Okamura KH, Nakamura BJ, Mueller C, Hayashi K, McMillan CKH. An Exploratory Factor Analysis of the Knowledge of Evidence-Based Services Questionnaire. J Behav Health Serv Res 2017; 43:214-32. [PMID: 24488613 DOI: 10.1007/s11414-013-9384-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recent developments for disseminating and implementing evidence-based practices (EBPs) have emphasized the importance of increasing therapists' knowledge of such techniques. However, systematic efforts to measure knowledge in therapists serving youth have mostly relied on poorly researched study-specific measures. This study investigated the structure of EBP knowledge in a large sample of youth community therapists (N = 240) via a therapist report instrument emphasizing therapeutic commonalities across various types of treatment approaches. Findings supported a three-factor structure of knowledge with scores on factors varying by therapists' primary practice setting and education level. The relationships between therapist knowledge of and attitudes towards EBPs are also discussed.
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Affiliation(s)
- Kelsie H Okamura
- Department of Psychology, University of Hawaii at Manoa, 2530 Dole Street, Sakamaki C-400, Honolulu, HI, 96822, USA.
| | - Brad J Nakamura
- Department of Psychology, University of Hawaii at Manoa, 2530 Dole Street, Sakamaki C-400, Honolulu, HI, 96822, USA
| | - Charles Mueller
- Department of Psychology, University of Hawaii at Manoa, 2530 Dole Street, Sakamaki C-400, Honolulu, HI, 96822, USA
| | - Kentaro Hayashi
- Department of Psychology, University of Hawaii at Manoa, 2530 Dole Street, Sakamaki C-400, Honolulu, HI, 96822, USA
| | - Charmaine K Higa McMillan
- Department of Psychology, University of Hawaii at Hilo, 200 West Kawili Street, Hilo, HI, 96720, USA
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What Did They Learn? Effects of a Brief Cognitive Behavioral Therapy Workshop on Community Therapists' Knowledge. Community Ment Health J 2016; 52:998-1003. [PMID: 25894649 PMCID: PMC4609580 DOI: 10.1007/s10597-015-9876-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 04/09/2015] [Indexed: 12/25/2022]
Abstract
Knowledge gain has been identified as necessary but not sufficient for therapist behavior change. Declarative knowledge, or factual knowledge, is thought to serve as a prerequisite for procedural knowledge, the how to knowledge system, and reflective knowledge, the skill refinement system. The study aimed to examine how a 1-day workshop affected therapist cognitive behavioral therapy declarative knowledge. Participating community therapists completed a test before and after training that assessed cognitive behavioral therapy knowledge. Results suggest that the workshop significantly increased declarative knowledge. However, post-training total scores remained moderately low, with several questions answered incorrectly despite content coverage in the workshop. These findings may have important implications for structuring effective cognitive behavioral therapy training efforts and for the successful implementation of cognitive behavioral therapy in community settings.
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45
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Padmanabhanunni A, Sui XC. Mental healthcare providers’ attitudes towards the adoption of evidence-based practice in the treatment of post-traumatic stress disorder in South Africa. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1177/0081246316673244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
South African society is characterised by a high prevalence of exposure to traumatic events that can lead to post-traumatic stress disorder. In treating post-traumatic stress disorder, mental healthcare providers are tasked with ensuring that their practice is evidence based. However, existing evidence indicates that the rates of adoption of evidence-based practice are generally poor. The promotion and implementation of evidence-based practice into routine clinical settings requires an understanding of the attitudes of mental healthcare providers towards these practices. This study investigated attitudes towards evidence-based practice in the treatment of post-traumatic stress disorder. Participants were 60 mental healthcare providers (clinical/counselling psychologists, social workers, and registered counsellors) in the Western Cape Province working predominantly with trauma survivors. Participants completed a demographic survey and the Attitude Towards Evidence-Based Practice Scale, adapted to assess for attitudes towards the adoption of evidence-based practice in relation to the treatment of post-traumatic stress disorder. Overall, participants reported favourable attitudes towards evidence-based practice in the treatment of post-traumatic stress disorder. Statistical analysis revealed that occupation, age, and gender significantly correlated with attitudes. Social workers and registered counsellors were more likely to report adopting evidence-based practice for post-traumatic stress disorder compared to clinical and counselling psychologists. Older participants and women also reported more favourable attitudes towards evidence-based practice. The implications of these findings are discussed.
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Egeland KM, Ruud T, Ogden T, Lindstrøm JC, Heiervang KS. Psychometric properties of the Norwegian version of the Evidence-Based Practice Attitude Scale (EBPAS): to measure implementation readiness. Health Res Policy Syst 2016; 14:47. [PMID: 27316675 PMCID: PMC4912744 DOI: 10.1186/s12961-016-0114-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/31/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attitudes can be a precursor to the decision of whether or not to try a new practice. In order to tailor the implementation of evidence-based practices (EBPs) in mental health settings, we must first consider practitioner attitudes towards EBP adoption. To assess these attitudes, the Evidence-Based Practice Attitude Scale (EBPAS) was developed. The purpose of this study was to investigate the psychometric properties of the Norwegian version of the EBPAS, and to examine differences in attitudes towards implementing EBPs among mental health practitioners. METHODS The EBPAS was translated into Norwegian and administered to 294 practitioners from seven primary and 22 specialized mental care units within a defined geographical area of Norway. RESULTS The EBPAS showed good psychometric properties. The less clinical experience the practitioner had, the more positive their attitude toward EBPs. Primary care practitioners reported more positive attitudes towards implementing EBPs that were required of them than specialized care practitioners. CONCLUSIONS The Norwegian version of the EBPAS is a promising tool for measuring implementation readiness in mental health services, and can be used in clinical practice to tailor implementation efforts. TRIAL REGISTRATION The study was approved by the regional committees for medical and health research ethics [ REK 2013/2035 ] on 25(th) of May, 2014.
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Affiliation(s)
- Karina M Egeland
- Akershus University Hospital, Division of Mental Health Services, Sykehusveien 25, 1478, Lørenskog, Norway.
| | - Torleif Ruud
- Akershus University Hospital, Division of Mental Health Services, Sykehusveien 25, 1478, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Terje Ogden
- Norwegian Center for Child Behavioral Development, Essendropsgate 3, 0368, Oslo, Norway
- Institute of Psychology, University of Oslo, Essendropsgate 3, 0368, Oslo, Norway
| | - Jonas Christoffer Lindstrøm
- Helse Sør-Øst Health Services Research Centre, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway
| | - Kristin Sverdvik Heiervang
- Akershus University Hospital, Division of Mental Health Services, Sykehusveien 25, 1478, Lørenskog, Norway
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Lyon AR, Koerner K. User-Centered Design for Psychosocial Intervention Development and Implementation. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016; 23:180-200. [PMID: 29456295 PMCID: PMC5812700 DOI: 10.1111/cpsp.12154] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The current paper articulates how common difficulties encountered when attempting to implement or scale-up evidence-based treatments are exacerbated by fundamental design problems, which may be addressed by a set of principles and methods drawn from the contemporary field of user-centered design. User-centered design is an approach to product development that grounds the process in information collected about the individuals and settings where products will ultimately be used. To demonstrate the utility of this perspective, we present four design concepts and methods: (a) clear identification of end users and their needs, (b) prototyping/rapid iteration, (c) simplifying existing intervention parameters/procedures, and (d) exploiting natural constraints. We conclude with a brief design-focused research agenda for the developers and implementers of evidence-based treatments.
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Park H, Ebesutani CK, Chung KM, Stanick C. Cross-Cultural Validation of the Modified Practice Attitudes Scale: Initial Factor Analysis and a New Factor Model. Assessment 2016; 25:126-138. [PMID: 26969687 DOI: 10.1177/1073191116634202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to create the Korean version of the Modified Practice Attitudes Scale (K-MPAS) to measure clinicians' attitudes toward evidence-based treatments (EBTs) in the Korean mental health system. METHOD Using 189 U.S. therapists and 283 members from the Korean mental health system, we examined the reliability and validity of the MPAS scores. We also conducted the first exploratory and confirmatory factor analysis on the MPAS and compared EBT attitudes across U.S. and Korean therapists. RESULTS Results revealed that the inclusion of both "reversed-worded" and "non-reversed-worded" items introduced significant method effects that compromised the integrity of the one-factor MPAS model. Problems with the one-factor structure were resolved by eliminating the "non-reversed-worded" items. Reliability and validity were adequate among both Korean and U.S. therapists. Korean therapists also reported significantly more negative attitudes toward EBTs on the MPAS than U.S. therapists. CONCLUSIONS The K-MPAS is the first questionnaire designed to measure Korean service providers' attitudes toward EBTs to help advance the dissemination of EBTs in Korea. The current study also demonstrated the negative impacts that can be introduced by incorporating oppositely worded items into a scale, particularly with respect to factor structure and detecting significant group differences.
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Lau AS, Brookman-Frazee L. The 4KEEPS study: identifying predictors of sustainment of multiple practices fiscally mandated in children's mental health services. Implement Sci 2016; 11:31. [PMID: 26956621 PMCID: PMC4784305 DOI: 10.1186/s13012-016-0388-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/23/2016] [Indexed: 11/19/2022] Open
Abstract
Background Research to date has largely focused on predictors of adoption and initial implementation of evidence-based practices (EBPs), yet sustained implementation is crucial to deliver a return on investments in dissemination. Furthermore, most studies focus on single EBPs, limiting opportunities to study the fit between practice characteristics EBPs and implementation contexts. Methods/design This observational study will characterize implementation sustainment and identify organizational and therapist characteristics that predict sustainment of multiple practices being implemented within a fiscal mandate in the largest public mental health system in the USA. Specific aims are to (1) characterize sustainment outcomes (volume/penetration, EBP concordant care); (2) use mixed methods to characterize inner context (agency- and therapist-level) factors and early implementation conditions; and (3) identify inner context factors and early implementation conditions that predict sustainment outcomes. This study will undertake original data collection and analysis of existing data sources to achieve its aims. Archived reports and documents will be used to characterize early implementation conditions in 102 agencies. Administrative claims data will be used to characterize volume and penetration outcomes over 8 years. Therapist and program manager surveys will be administered to characterize sustained EBP concordant care and inner context determinants of sustainment. An in-depth study in a subset of agencies will yield interview data and recordings of treatment sessions for validation of the EBP concordant care scale. Discussion This project will yield new understanding of whether and how multiple EBPs can be sustained in public mental health systems undergoing a policy-driven community implementation effort. We will produce generalizable models for characterizing sustainment, including feasible and flexible measurement of practice across multiple EBPs. The findings will inform the development of implementation interventions to promote sustained delivery of EBPs to maximize their public health impact. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0388-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna S Lau
- University of California, Los Angeles, USA.
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van Sonsbeek MAMS, Hutschemaekers GJM, Veerman JW, Kleinjan M, Aarons GA, Tiemens BG. Psychometric properties of the Dutch version of the Evidence-Based Practice Attitude Scale (EBPAS). Health Res Policy Syst 2015; 13:69. [PMID: 26572126 PMCID: PMC4647622 DOI: 10.1186/s12961-015-0058-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 11/01/2015] [Indexed: 11/18/2022] Open
Abstract
Background The Evidence-Based Practice Attitude Scale (EBPAS) was developed in the United States to assess attitudes of mental health and welfare professionals toward evidence-based interventions. Although the EBPAS has been translated in different languages and is being used in several countries, all research on the psychometric properties of the EBPAS within youth care has been carried out in the United States. The purpose of this study was to investigate the psychometric properties of the Dutch version of the EBPAS. Methods After translation into Dutch, the Dutch version of the EBPAS was examined in a diverse sample of 270 youth care professionals working in five institutions in the Netherlands. We examined the factor structure with both exploratory and confirmatory factor analyses and the internal consistency reliability. We also conducted multiple linear regression analyses to examine the association of EBPAS scores with professionals’ characteristics. It was hypothesized that responses to the EBPAS items could be explained by one general factor plus four specific factors, good to excellent internal consistency reliability would be found, and EBPAS scores would vary by age, sex, and educational level. Results The exploratory factor analysis suggested a four-factor solution according to the hypothesized dimensions: Requirements, Appeal, Openness, and Divergence. Cronbach’s alphas ranged from 0.67 to 0.89, and the overall scale alpha was 0.72. The confirmatory factor analyses confirmed the factor structure and suggested that the lower order EBPAS factors are indicators of a higher order construct. However, Divergence was not significantly correlated with any of the subscales or the total score. The confirmatory bifactor analysis endorsed that variance was explained both by a general attitude towards evidence-based interventions and by four specific factors. The regression analyses showed an association between EBPAS scores and youth care professionals’ age, sex, and educational level. Conclusions The present study provides strong support for a structure with a general factor plus four specific factors and internal consistency reliability of the Dutch version of the EBPAS in a diverse sample of youth care professionals. Hence, the factor structure and reliability of the original version of the EBPAS seem generalizable to the Dutch version of the EBPAS.
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Affiliation(s)
- Maartje A M S van Sonsbeek
- Behavioural Science Institute, Radboud University, Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands. .,Pro Persona Centre for Education & Science (ProCES), Postbus 27, 6870 AA, Renkum, The Netherlands.
| | - Giel J M Hutschemaekers
- Behavioural Science Institute, Radboud University, Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands. .,Pro Persona Centre for Education & Science (ProCES), Postbus 27, 6870 AA, Renkum, The Netherlands.
| | - Jan W Veerman
- Behavioural Science Institute, Radboud University, Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands.
| | - Marloes Kleinjan
- Department of Epidemiology, Trimbos Institute, Da Costakade 45, 3521 VS, Utrecht, The Netherlands.
| | - Gregory A Aarons
- Department of Psychiatry, University of California, 9500 Gilman Drive, San Diego, La Jolla, CA, 92093-0812, USA. .,Child and Adolescent Services Research Center, 3020 Children's Way, San Diego, CA, 92123, USA.
| | - Bea G Tiemens
- Behavioural Science Institute, Radboud University, Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands. .,Pro Persona Centre for Education & Science (ProCES), Postbus 27, 6870 AA, Renkum, The Netherlands.
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