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Javvaji CK, Vagha JD, Meshram RJ, Taksande A. Assessment Scales in Cerebral Palsy: A Comprehensive Review of Tools and Applications. Cureus 2023; 15:e47939. [PMID: 38034189 PMCID: PMC10685081 DOI: 10.7759/cureus.47939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/28/2023] [Indexed: 12/02/2023] Open
Abstract
Cerebral palsy (CP) is a complex neurological condition characterized by motor dysfunction affecting millions worldwide. This comprehensive review delves into the critical role of assessment in managing CP. Beginning with exploring its definition and background, we elucidate the diverse objectives of CP assessment, ranging from diagnosis and goal setting to research and epidemiology. We examine standard assessment scales and tools, discuss the challenges inherent in CP assessment, and highlight emerging trends, including integrating technology, personalized medicine, and neuroimaging. The applications of CP assessment in clinical diagnosis, treatment planning, research, and education are underscored. Recommendations for the future encompass standardization, interdisciplinary collaboration, research priorities, and professional training. In conclusion, we emphasize the importance of assessment as a compass guiding the care of individuals with CP, issuing a call to action for improved assessment practices to shape a brighter future for those affected by this condition.
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Affiliation(s)
- Chaitanya Kumar Javvaji
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jayant D Vagha
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Revat J Meshram
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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2
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Kyei-Arthur F, Kyei-Gyamfi S. Alcohol consumption and risky sexual behaviors among fishers in Elmina in Ghana. BMC Public Health 2023; 23:1328. [PMID: 37434125 PMCID: PMC10337065 DOI: 10.1186/s12889-023-16239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Alcohol consumption is part of human social behavior and constitutes a routine part of social life in many countries. Prior studies have found over-indulgence of fishers in alcohol in fishing communities. The study uses the Alcohol Myopia Theory (AMT) to analyze and explain the phenomena of fishers engaging in sex after alcohol consumption, and condom use with sexual partner(s) after alcohol consumption. The study investigated alcohol consumption, predictors of alcohol consumption, and the reasons for drinking alcohol among fishers. It also examined fishers' engagement in sex after alcohol consumption, the use of condoms with sexual partners after drinking alcohol, and predictors of the use of condoms with sexual partners after drinking alcohol. METHODS A cross-sectional convergent parallel mixed-method design was used to study 385 fishers in Elmina. Also, two focus group discussions were conducted among male and female fishers. Descriptive statistics were used to analyze the quantitative data, while the qualitative data was analyzed thematically. RESULTS Generally, 59.2% of participants indulged in alcohol consumption. Most male participants (70.6%) indulged in alcohol consumption than female participants (48.5%). Also, 48.5% of participants indulged in binge alcohol consumption, while 38.1% indulged in moderate alcohol consumption. The predictors of alcohol consumption were sex, religion, and type of fishing occupation. Participants identified consuming alcohol to kill loneliness and boredom, to forget family and work-related issues, and to have fun as reasons why fishers consume alcohol. Sixty-four percent of participants have ever engaged in sexual intercourse after consuming alcohol in the past 12 months. However, 70% of participants did not use a condom the last time they had sex after drinking alcohol. Only ethnicity of participants predicted their use of a condom the last time they had sex after drinking alcohol. The primary reasons for the non-use of condoms were do not like using condoms (37.9%), forgetting to use a condom (33.0%), and had sex with a trusted regular partner (15.5%). CONCLUSIONS This study demonstrated that alcohol consumption was prevalent among fishers, especially among male fishers, which contributes to risky sexual behaviors among them as espoused by the AMT. It is recommended that fishers are targeted for alcohol use and risky sexual behavior programs and interventions since alcohol use is prevalent among them and most of them also engage in unprotected sexual intercourse after consuming alcohol.
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Affiliation(s)
- Frank Kyei-Arthur
- Department of Environment and Public Health, University of Environment and Sustainable Development, Somanya, Ghana.
| | - Sylvester Kyei-Gyamfi
- Department of Children, Ministry of Gender, Children and Social Protection, Accra, Ghana
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Hobensack M, Song J, Scharp D, Bowles KH, Topaz M. Machine learning applied to electronic health record data in home healthcare: A scoping review. Int J Med Inform 2023; 170:104978. [PMID: 36592572 PMCID: PMC9869861 DOI: 10.1016/j.ijmedinf.2022.104978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Despite recent calls for home healthcare (HHC) to integrate informatics, the application of machine learning in HHC is relatively unknown. Thus, this study aimed to synthesize and appraise the literature describing the application of machine learning to predict adverse outcomes (e.g., hospitalization, mortality) using electronic health record (EHR) data in the HHC setting. Our secondary aim was to evaluate the comprehensiveness of predictors used in the machine learning algorithms guided by the Biopsychosocial Model. METHODS During March 2022 we conducted a literature search in four databases: PubMed, Embase, CINAHL, and Scopus. Inclusion criteria were 1) describing services provided in the HHC setting, 2) applying machine learning algorithms to predict adverse outcomes, defined as outcomes related to patient deterioration, 3) using EHR data and 4) focusing on the adult population. Predictors were mapped to the Biopsychosocial Model. A risk of bias analysis was conducted using the Prediction Model Risk Of Bias Assessment Tool. RESULTS The final sample included 20 studies. Eighteen studies used predictors from standardized assessments integrated in the EHR. The most common outcome of interest was hospitalization (55%), followed by mortality (25%). Psychological predictors were frequently excluded (35%). Tree based algorithms were most frequently applied (75%). Most studies demonstrated high or unclear risk of bias (75%). CONCLUSION Future studies in HHC should consider incorporating machine learning algorithms into clinical decision support systems to identify patients at risk. Based on the Biopsychosocial model, psychological and interpersonal characteristics should be used along with biological characteristics to enhance risk prediction. To facilitate the widespread adoption of machine learning, stakeholders should encourage standardization in the HHC setting.
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Affiliation(s)
| | - Jiyoun Song
- Columbia University School of Nursing, New York, NY, USA.
| | | | - Kathryn H Bowles
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA; Center for Home Care Policy & Research, VNS Health, New York, NY, USA.
| | - Maxim Topaz
- Columbia University School of Nursing, New York, NY, USA; Center for Home Care Policy & Research, VNS Health, New York, NY, USA; Data Science Institute, Columbia University, New York, NY, USA.
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4
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Lyon AR, Liu FF, Connors EH, King KM, Coifman JI, Cook H, McRee E, Ludwig K, Law A, Dorsey S, McCauley E. How low can you go? Examining the effects of brief online training and post-training consultation dose on implementation mechanisms and outcomes for measurement-based care. Implement Sci Commun 2022; 3:79. [PMID: 35869500 PMCID: PMC9306246 DOI: 10.1186/s43058-022-00325-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 07/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Initial training and ongoing post-training consultation (i.e., ongoing support following training, provided by an expert) are among the most common implementation strategies used to change clinician practice. However, extant research has not experimentally investigated the optimal dosages of consultation necessary to produce desired outcomes. Moreover, the degree to which training and consultation engage theoretical implementation mechanisms-such as provider knowledge, skills, and attitudes-is not well understood. This study examined the effects of a brief online training and varying dosages of post-training consultation (BOLT+PTC) on implementation mechanisms and outcomes for measurement-based care (MBC) practices delivered in the context of education sector mental health services. METHODS A national sample of 75 clinicians who provide mental health interventions to children and adolescents in schools were randomly assigned to BOLT+PTC or control (services as usual). Those in BOLT+PTC were further randomized to 2-, 4-, or 8-week consultation conditions. Self-reported MBC knowledge, skills, attitudes, and use (including standardized assessment, individualized assessment, and assessment-informed treatment modification) were collected for 32 weeks. Multilevel models were used to examine main effects of BOLT+PTC versus control on MBC use at the end of consultation and over time, as well as comparisons among PTC dosage conditions and theorized mechanisms (skills, attitudes, knowledge). RESULTS There was a significant linear effect of BOLT+PTC over time on standardized assessment use (b = .02, p < .01), and a significant quadratic effect of BOLT+PTC over time on individualized assessment use (b = .04, p < .001), but no significant effect on treatment modification. BOLT + any level of PTC resulted in higher MBC knowledge and larger growth in MBC skill over the intervention period as compared to control. PTC dosage levels were inconsistently predictive of outcomes, providing no clear evidence for added benefit of higher PTC dosage. CONCLUSIONS Online training and consultation in MBC had effects on standardized and individualized assessment use among clinicians as compared to services as usual with no consistent benefit detected for increased consultation dosage. Continued research investigating optimal dosages and mechanisms of these established implementation strategies is needed to ensure training and consultation resources are deployed efficiently to impact clinician practices. TRIAL REGISTRATION ClinicalTrials.gov NCT05041517 . Retrospectively registered on 10 September 2021.
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Affiliation(s)
- Aaron R. Lyon
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Freda F. Liu
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Elizabeth H. Connors
- grid.47100.320000000419368710Department of Psychiatry, Yale University, 389 Whitney Avenue, Office 106, New Haven, CT 06511 USA
| | - Kevin M. King
- grid.34477.330000000122986657Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Jessica I. Coifman
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Heather Cook
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Erin McRee
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Kristy Ludwig
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Amy Law
- grid.34477.330000000122986657Graduate Medical Education, University of Washington, Learning Gateway, Box 358220, Seattle, WA 98109 USA
| | - Shannon Dorsey
- grid.34477.330000000122986657Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Elizabeth McCauley
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
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Lane V, Lane M, Sturrock A, Rickards H. Understanding Psychiatric Disorders in Idiopathic and Inherited (Monogenic) Forms of Isolated and Combined Dystonia: A Systematic Review. J Neuropsychiatry Clin Neurosci 2021; 33:295-306. [PMID: 34280321 DOI: 10.1176/appi.neuropsych.20110293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The relationship between idiopathic and inherited (monogenic) forms of isolated and combined dystonia and psychiatric disorders remains unclear. In the present review, the authors aimed to provide increased clarity on this association through a systematic review of all controlled quantitative studies using a structured or semi-structured psychiatric interview to diagnose psychiatric disorders in individuals with these conditions. METHODS Three databases were searched to identify 20 eligible studies, with a total of 1,275 participants fulfilling inclusion criteria. Eligible articles were quality appraised and divided into four sections (idiopathic forms of dystonia [N=11], early-onset torsion dystonia [N=2], gene mutation positive myoclonus dystonia; DYT-SGCE [N=6], and rapid-onset dystonia-parkinsonism [N=1]). RESULTS For each study, results were grouped into subcategories (overall psychiatric comorbidity, anxiety disorders, mood disorders, substance misuse, and other [personality disorder and cognitive impairment]). For idiopathic dystonia, higher rates of psychiatric comorbidity, including mood and anxiety disorders, were noted when cases were compared with both healthy control subjects and control groups with a medical comorbidity. However, for major depressive disorder and obsessive-compulsive disorder (OCD) specifically, no differences were seen between groups. Study subjects with DYT-SGCE appeared to be at higher risk of psychiatric comorbidity, major depressive disorder, OCD, and alcohol dependence than control populations. CONCLUSIONS Overall, the prevalence of psychiatric comorbidity appears to be increased in individuals with idiopathic and inherited (monogenic) forms of isolated and combined dystonia compared with control subjects. This finding is not consistent for all comparisons, and further research is required to understand the nature of these associations and the underlying causative etiologies.
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Affiliation(s)
- Victoria Lane
- Neuropsychiatric Department, Barberry National Centre for Mental Health, Birmingham, United Kingdom
| | - Mark Lane
- Neuropsychiatric Department, Barberry National Centre for Mental Health, Birmingham, United Kingdom
| | - Aaron Sturrock
- Neuropsychiatric Department, Barberry National Centre for Mental Health, Birmingham, United Kingdom
| | - Hugh Rickards
- Neuropsychiatric Department, Barberry National Centre for Mental Health, Birmingham, United Kingdom
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Middle and High School Student Perspectives on Digitally-Delivered Mental Health Assessments and Measurement Feedback Systems. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:531-544. [PMID: 31938974 DOI: 10.1007/s10488-020-01010-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Implementation of measurement-based care (MBC) by child-serving community mental health providers, particularly school-based providers, is low. To inform user-centered design of measurement feedback systems (MFSs) and MBC implementation more broadly, semi-structured interviews were conducted with 61 middle and high school students. Interviews explored student preferences for and perceived helpfulness of different assessment methods and use of MFS in counseling. Results indicate that student preference for digitally-administered assessment is equivocal, with preferences being influenced by student perceptions of the ease of use, impersonalization, and confidentiality. Students with exposure to the MFS found it helpful when used by their provider to share assessment feedback.
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Patel ZS, Jensen-Doss A, Zopluoglu C. Illustrating the Applicability of IRT to Implementation Science: Examining an Instrument of Therapist Attitudes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:921-935. [PMID: 33929639 DOI: 10.1007/s10488-021-01139-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
Pragmatic instruments with psychometric support are important to advance dissemination and implementation (D&I) research, but few well-researched D&I instruments exist. Item response theory (IRT), an approach that is underutilized in D&I, can help with the development of actionable and brief instruments. This paper provides an overview of IRT for D&I researchers and examines an instrument of therapist attitudes using IRT measurement models. Eight items of the Attitudes Towards Individualized Assessment-Monitoring and Feedback (AIA-MF) Clinical Utility scale were fit to the Graded Response Model in a national sample of master's level therapists. Various IRT model characteristics including item threshold and discrimination parameters, information, and item and person fit were examined. Discrimination and thresholds parameters showed significant variability across the eight items. Item information curves also showed that each item contributed variably to the total test information, suggesting that items 4 and 5 reliably measure therapist attitudes across the latent continuum and items 3 and 6 warrant further investigation. Results suggest that IRT models can help D&I researchers examine existing instruments with greater specificity than traditional measurement methods, thus increasing measurement precision while lowering response burden, both important considerations for the field.
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Affiliation(s)
- Zabin S Patel
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA.
| | - Amanda Jensen-Doss
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
| | - Cengiz Zopluoglu
- Department of Educational Methodology, Policy, and Leadership, University of Oregon, Eugene, OR, 97403, USA
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8
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Use of Standardized and Non-Standardized Tools for Measuring the Risk of Falls and Independence in Clinical Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063226. [PMID: 33804715 PMCID: PMC8004039 DOI: 10.3390/ijerph18063226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 01/20/2023]
Abstract
(1) Background: The use of standardized tools is regarded as the basis for an evidence-based assessment. The tools enable monitoring of complex events and the effectiveness of adopted interventions. Some healthcare facilities use standardized tools such as the Morse Fall Scale, but many use non-standardized tools created based on patient needs. Our study question was, why are non-standardized tools used when standardized tools are more beneficial and can be statistically evaluated and compared to other results; (2) Methods: We used a quantitative, non-standardized questionnaire to survey 1200 nurses, which was representative sample for the entire Czech Republic. All questionnaires were assessed in two phases (a) the frequency evaluation and descriptive analysis, and (b) hypotheses testing and correlation analyses; (3) Results: We found that the Conley Scale, Barthel test, and IADL test were preferred by many nurses. Furthermore, we found that nurses using standardized assessment scales noticed risk factors significantly more frequently but regarded the increased complexity of care to be psychologically demanding. (4) Conclusions: In patients with physical disabilities, both types of tools (internal non-standardized and standardized) are used to assess the risk of falls and independence; nurses generally welcomed the increase use of standardized tools in their facilities.
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Bryant A, Guy J, Holmes J. The Strengths and Difficulties Questionnaire Predicts Concurrent Mental Health Difficulties in a Transdiagnostic Sample of Struggling Learners. Front Psychol 2020; 11:587821. [PMID: 33329246 PMCID: PMC7717974 DOI: 10.3389/fpsyg.2020.587821] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022] Open
Abstract
Children and adolescents with developmental problems are at increased risk of experiencing mental health problems. The Strengths and Difficulties Questionnaire (SDQ) is widely used as a screener for detecting mental health difficulties in these populations, but its use thus far has been restricted to groups of children with diagnosed disorders (e.g., ADHD). Transdiagnostic approaches, which focus on symptoms and soften or remove the boundaries between traditional categorical disorders, are increasingly adopted in research and practice. The aim of this study was to assess the potential of the SDQ to detect concurrent mental health problems in a transdiagnostic sample of children. The sample were referred by health and educational professionals for difficulties related to learning (N = 389). Some had one diagnosis, others had multiple, but many had no diagnoses. Parent-rated SDQ scores were significantly positively correlated with parent ratings of mental health difficulties on the Revised Child Anxiety and Depression Scale (RCADS). Ratings on the SDQ Emotion subscale significantly predicted the likelihood of having concurrent clinical anxiety and depression scores. Ratings on the Hyperactivity subscale predicted concurrent anxiety levels. These findings suggest the SDQ could be a valuable screening tool for identifying existing mental health difficulties in children recognized as struggling, as it can be in typically developing children and those with specific diagnoses.
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Affiliation(s)
- Annie Bryant
- Department of Clinical Psychology, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Jacalyn Guy
- Medical Research Council (MRC) Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Joni Holmes
- Medical Research Council (MRC) Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
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10
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Challenges in Investigating the Effective Components of Feedback from Routine Outcome Monitoring (ROM) in Youth Mental Health Care. CHILD & YOUTH CARE FORUM 2020. [DOI: 10.1007/s10566-020-09574-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
BackGround
Studies on feedback in youth mental health care are scarce and implementation of feedback into clinical practice is problematic.
Objective
To investigate potentially effective components of feedback from Routine Outcome Monitoring (ROM) in youth mental health care in the Netherlands through a three-arm, parallel-group, randomized controlled trial in which a literature-based, multi-faceted implementation strategy was used.
Method
Participants were randomly allocated to three conditions (basic feedback about symptoms and quality of life; basic feedback supplemented with clinical support tools; discussion of the feedback of the second condition with a colleague while following a standardized format for case consultation) using a block randomization procedure, stratified by location and participants’ age. The youth sample consisted of 225 participants (mean age = 15.08 years; 61.8% female) and the parent sample of 234 mothers and 54 fathers (mean age of children = 12.50 years; 47.2% female). Primary outcome was symptom severity. Secondary outcomes were quality of life and end-of-treatment variables. Additionally, we evaluated whether being Not On Track (NOT) moderated the association between condition and changes in symptom severity.
Results
No significant differences between conditions and no moderating effect of being NOT were found. This outcome can probably be attributed to limited power and implementation difficulties, such as infrequent ROM, unknown levels of viewing and sharing of feedback, and clinicians’ poor adherence to feedback conditions.
Conclusions
The study contributes to our limited knowledge about feedback from ROM and underscores the complexity of research on and implementation of ROM within youth mental health care.
Trial registration Dutch Trial Register NTR4234 .
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Lyon AR, Whitaker K, Richardson LP, French WP, McCauley E. Collaborative Care to Improve Access and Quality in School-Based Behavioral Health. THE JOURNAL OF SCHOOL HEALTH 2019; 89:1013-1023. [PMID: 31612501 DOI: 10.1111/josh.12843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/27/2018] [Accepted: 08/12/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND Collaborative care (CC) is a well-established approach for the delivery of accessible behavioral health services in integrated health care settings. Substantial evidence supports its effectiveness in improving the quality and outcomes of adult services, and growing research indicates utility with child and adolescent populations. METHODS To date, studies examining CC models for youth have focused exclusively on primary-care settings. Nevertheless, as the most common integrated service delivery setting for youth, the education sector is an equally important context for improving access to behavioral health services for children and adolescents. RESULTS We provide a narrative review of the literature on CC, describes the relevance of CC to schools, and details its alignment with contemporary movements in education and school-based behavioral health. CONCLUSIONS Potential adaptations of the CC model for use in schools are detailed to improve: (1) behavioral health service accessibility, (2) the capacity of schools to provide behavioral health services, and (3) school service effectiveness through use of evidence-based practices. Although little research has explored the applicability of CC in the education sector, the model holds potential promise to improve the quality and efficiency of school-based behavioral health services.
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Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115
| | - Kelly Whitaker
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115
| | - Laura P Richardson
- University of Washington/Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, M/S CW8-6, Seattle, WA, 98121
| | - William P French
- University of Washington, 4800 Sand Point Way NE, M/S OA.5.154, PO Box 5371, Seattle, WA, 98145
| | - Elizabeth McCauley
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115
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Bjaastad JF, Jensen-Doss A, Moltu C, Jakobsen P, Hagenberg H, Joa I. Attitudes toward standardized assessment tools and their use among clinicians in a public mental health service. Nord J Psychiatry 2019; 73:387-396. [PMID: 31322010 DOI: 10.1080/08039488.2019.1642383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of the present study was to investigate the use and attitudes toward standardized assessment tools among clinicians in a public mental health service in Norway. A total of 606 clinicians provided feedback on their use and attitudes regarding psychometric qualities of such tools, their practicality, and their benefit over clinical judgment alone using the Attitudes toward Standardized Assessment (ASA) Scales. Clinicians working in the adult mental health field scored significantly higher on use of diagnostic interviews, pre-post evaluations, and ongoing evaluations, whereas clinicians working in the child/adolescent mental health field scored significantly higher on use of screening instruments and held more positive attitudes towards using standardized assessment tools. Attitudes toward standardized assessment tools predicted use of such tools, and results were found to be similar to a study on US clinicians. Whereas the US study only found attitudes regarding the practicality of using such instrument as an independent predictor of assessment use, the current study found that attitudes regarding psychometric qualities of such tools, their practicality, and their benefit over clinical judgment alone were independent predictors of use.
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Affiliation(s)
- Jon Fauskanger Bjaastad
- Division of Psychiatry, Stavanger University Hospital , Stavanger , Norway.,Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre , Bergen , Norway
| | | | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde , Førde , Norway
| | - Petter Jakobsen
- Division of Psychiatry, Haukeland University Hospital , Bergen , Norway.,Department of Clinical Medicine, University of Bergen , Bergen , Norway
| | - Heine Hagenberg
- Division of Psychiatry, District General Hospital of Fonna , Haugesund , Norway
| | - Inge Joa
- TIPS - Network for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital , Stavanger , Norway.,The Interprofessional Network for Medical Sciences, Department of Public Health, Faculty of Health Sciences, University of Stavanger , Stavanger , Norway
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13
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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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Jensen-Doss A, Smith AM, Becker-Haimes EM, Mora Ringle V, Walsh LM, Nanda M, Walsh SL, Maxwell CA, Lyon AR. Individualized Progress Measures Are More Acceptable to Clinicians Than Standardized Measures: Results of a National Survey. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:392-403. [PMID: 29143173 DOI: 10.1007/s10488-017-0833-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite research supporting measurement-based care grounded in standardized progress measures, such measures are underutilized by clinicians. Individualized measures of client-specific targets present an alternative, but little is known about their acceptability or use. We compared attitudes toward and use of standardized and individualized progress measures in a national sample of 504 clinicians. Clinicians reported neutral to positive attitudes toward both types of measures, but strongly preferred and were more likely to use individualized measures. Clinician attitudes, theoretical orientation, and work setting predicted assessment preferences and practices. Implications for dissemination and implementation of measurement-based care are discussed.
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Affiliation(s)
- Amanda Jensen-Doss
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA.
| | - Ashley M Smith
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA.,University of California, Los Angeles, USA
| | | | - Vanesa Mora Ringle
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | - Lucia M Walsh
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | - Monica Nanda
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | | | - Colleen A Maxwell
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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15
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Hermes EDA, Lyon AR, Schueller SM, Glass JE. Measuring the Implementation of Behavioral Intervention Technologies: Recharacterization of Established Outcomes. J Med Internet Res 2019; 21:e11752. [PMID: 30681966 PMCID: PMC6367669 DOI: 10.2196/11752] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/18/2018] [Accepted: 10/20/2018] [Indexed: 01/23/2023] Open
Abstract
Behavioral intervention technologies (BITs) are websites, software, mobile apps, and sensors designed to help users address or change behaviors, cognitions, and emotional states. BITs have the potential to transform health care delivery, and early research has produced promising findings of efficacy. BITs also favor new models of health care delivery and provide novel data sources for measurement. However, there are few examples of successful BIT implementation and a lack of consensus on as well as inadequate descriptions of BIT implementation measurement. The aim of this viewpoint paper is to provide an overview and characterization of implementation outcomes for the study of BIT use in routine practice settings. Eight outcomes for the evaluation of implementation have been previously described: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability. In a proposed recharacterization of these outcomes with respect to BIT implementation, definitions are clarified, expansions to the level of analysis are identified, and unique measurement characteristics are discussed. Differences between BIT development and implementation, an increased focus on consumer-level outcomes, the expansion of providers who support BIT use, and the blending of BITs with traditional health care services are specifically discussed. BITs have the potential to transform health care delivery. Realizing this potential, however, will hinge on high-quality research that consistently and accurately measures how well such technologies have been integrated into health services. This overview and characterization of implementation outcomes support BIT research by identifying and proposing solutions for key theoretical and practical measurement challenges.
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Affiliation(s)
- Eric DA Hermes
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Stephen M Schueller
- Department of Psychological Science, University of California at Irvine, Irvine, CA, United States
| | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
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16
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Voth Schrag R, Edmond TE. Treatment Goals, Assessment, and Evaluation Practices in Rape Crisis Centers. VIOLENCE AND VICTIMS 2018; 33:1055-1071. [PMID: 30573550 DOI: 10.1891/0886-6708.33.6.1055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Counselors in Rape Crisis Centers (RCCs) provide crucial services to survivors of sexual violence. However, little is known about RCCs, including the treatment goals and assessment strategies of counselors. Counselors in all Texas RCCs (n = 83) were invited to participate in a web-based survey. Participants were asked to indicate which treatment goals they frequently identified and assessed, as well as their usual assessment techniques. Counselors endorsed treatment goals around self-esteem, empowerment, and relational functioning, along with trauma and mental health. Fewer counselors endorsed goals around drugs/alcohol or school/work/sexual functioning. Few counselors reported use of standardized measures. Counselors in urban settings were more likely to endorse goals related to mental health. There are discrepancies between counselors' goals and how often outcomes are assessed. Increased assessment could promote the provision of effective services and access to funding.
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Affiliation(s)
- Rachel Voth Schrag
- School of Social Work, University of Texas at Arlington, Arlington, Texas
| | - Tonya E Edmond
- George Warren Brown School of Social Work at Washington University in St. Louis, St. Louis, Missouri
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17
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Lyon AR, Stanick C, Pullmann MD. Toward high‐fidelity treatment as usual: Evidence‐based intervention structures to improve usual care psychotherapy. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Pilot Test of an Engagement, Triage, and Brief Intervention Strategy for School Mental Health. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9277-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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19
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Lyon AR, Pullmann MD, Dorsey S, Martin P, Grigore AA, Becker EM, Jensen-Doss A. Reliability, Validity, and Factor Structure of the Current Assessment Practice Evaluation-Revised (CAPER) in a National Sample. J Behav Health Serv Res 2018; 46:43-63. [DOI: 10.1007/s11414-018-9621-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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How Do School Mental Health Services Vary Across Contexts? Lessons Learned from Two Efforts to Implement a Research-Based Strategy. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-017-9243-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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21
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Lyon AR, Connors E, Jensen-Doss A, Landes SJ, Lewis CC, McLeod BD, Rutt C, Stanick C, Weiner BJ. Intentional research design in implementation science: implications for the use of nomothetic and idiographic assessment. Transl Behav Med 2018; 7:567-580. [PMID: 28155110 DOI: 10.1007/s13142-017-0464-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The advancement of implementation science is dependent on identifying assessment strategies that can address implementation and clinical outcome variables in ways that are valid, relevant to stakeholders, and scalable. This paper presents a measurement agenda for implementation science that integrates the previously disparate assessment traditions of idiographic and nomothetic approaches. Although idiographic and nomothetic approaches are both used in implementation science, a review of the literature on this topic suggests that their selection can be indiscriminate, driven by convenience, and not explicitly tied to research study design. As a result, they are not typically combined deliberately or effectively. Thoughtful integration may simultaneously enhance both the rigor and relevance of assessments across multiple levels within health service systems. Background on nomothetic and idiographic assessment is provided as well as their potential to support research in implementation science. Drawing from an existing framework, seven structures (of various sequencing and weighting options) and five functions (Convergence, Complementarity, Expansion, Development, Sampling) for integrating conceptually distinct research methods are articulated as they apply to the deliberate, design-driven integration of nomothetic and idiographic assessment approaches. Specific examples and practical guidance are provided to inform research consistent with this framework. Selection and integration of idiographic and nomothetic assessments for implementation science research designs can be improved. The current paper argues for the deliberate application of a clear framework to improve the rigor and relevance of contemporary assessment strategies.
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Affiliation(s)
- Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA.
| | - Elizabeth Connors
- Department of Psychiatry, University of Maryland, School of Medicine, 737 West Lombard Street, office 420, Baltimore, MD, 21201, USA
| | - Amanda Jensen-Doss
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - Sara J Landes
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA.,VISN 16 Mental Illness Research, Education, and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, 72114, USA
| | - Cara C Lewis
- Department of Psychiatry and Behavioral Sciences, University of Washington, School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA.,Department of Psychological and Brain Sciences, Indiana University, 1101 E. 10th St, Bloomington, IN, 47405, USA
| | - Bryce D McLeod
- Department of Psychology, Virginia Commonwealth University, PO Box 842018, 806 W. Franklin Street, Richmond, VA, 23284, USA
| | - Christopher Rutt
- Department of Psychology, Harvard University, 33 Kirkland Street, William James Hall, Cambridge, MA, 02138, USA
| | - Cameo Stanick
- Department of Psychology, University of Montana, Skaggs Building Room 143, Missoula, MT, 59812, USA
| | - Bryan J Weiner
- University of North Carolina at Chapel Hill, 1102-C McGavran-Greenberg Hall, Chapel Hill, NC, 27516, USA
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22
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Lyon AR, Whitaker K, Locke J, Cook CR, King KM, Duong M, Davis C, Weist MD, Ehrhart MG, Aarons GA. The impact of inter-organizational alignment (IOA) on implementation outcomes: evaluating unique and shared organizational influences in education sector mental health. Implement Sci 2018; 13:24. [PMID: 29415749 PMCID: PMC5804008 DOI: 10.1186/s13012-018-0721-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrated healthcare delivered by work groups in nontraditional service settings is increasingly common, yet contemporary implementation frameworks typically assume a single organization-or organizational unit-within which system-level processes influence service quality and implementation success. Recent implementation frameworks predict that inter-organizational alignment (i.e., similarity in values, characteristics, activities related to implementation across organizations) may facilitate the implementation of evidence-based practices (EBP), but few studies have evaluated this premise. This study's aims examine the impact of overlapping organizational contexts by evaluating the implementation contexts of externally employed mental health clinicians working in schools-the most common integrated service delivery setting for children and adolescents. Aim 1 is to estimate the effects of unique intra-organizational implementation contexts and combined inter-organizational alignment on implementation outcomes. Aim 2 is to examine the underlying mechanisms through which inter-organizational alignment facilitates or hinders EBP implementation. METHODS/DESIGN This study will conduct sequential, exploratory mixed-methods research to evaluate the intra- and inter-organizational implementation contexts of schools and the external community-based organizations that most often employ school-based mental health clinicians, as they relate to mental health EBP implementation. Aim 1 will involve quantitative surveys with school-based, externally-employed mental health clinicians, their supervisors, and proximal school-employed staff (total n = 120 participants) to estimate the effects of each organization's general and implementation-specific organizational factors (e.g., climate, leadership) on implementation outcomes (fidelity, acceptability, appropriateness) and assess the moderating role of the degree of clinician embeddedness in the school setting. Aim 2 will explore the mechanisms through which inter-organizational alignment influences implementation outcomes by presenting the results of Aim 1 surveys to school-based clinicians (n = 30) and conducting semi-structured qualitative interviews. Qualitative data will be evaluated using an integrative inductive and deductive approach. DISCUSSION The study aims are expected to identify intra- and inter-organizational constructs that are most instrumental to EBP implementation success in school-based integrated care settings and illuminate mechanisms that may account for the influence of inter-organizational alignment. In addition to improving school-based mental health, these findings will spur future implementation science that considers the relationships across organizations and optimize the capacity of implementation science to guide practice in increasingly complex systems of care.
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Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA.
| | - Kelly Whitaker
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Jill Locke
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Clayton R Cook
- University of Minnesota, 250 Education Sciences Bldg, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Kevin M King
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Mylien Duong
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Chayna Davis
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Mark D Weist
- University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208, USA
| | - Mark G Ehrhart
- University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816-1390, USA
| | - Gregory A Aarons
- University of California San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093, USA.,Child and Adolescent Services Research Center, San Diego, 92123, CA, USA
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23
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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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24
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Jensen-Doss A, Haimes EMB, Smith AM, Lyon AR, Lewis CC, Stanick CF, Hawley KM. Monitoring Treatment Progress and Providing Feedback is Viewed Favorably but Rarely Used in Practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:48-61. [PMID: 27631610 PMCID: PMC5495625 DOI: 10.1007/s10488-016-0763-0] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Numerous trials demonstrate that monitoring client progress and using feedback for clinical decision-making enhances treatment outcomes, but available data suggest these practices are rare in clinical settings and no psychometrically validated measures exist for assessing attitudinal barriers to these practices. This national survey of 504 clinicians collected data on attitudes toward and use of monitoring and feedback. Two new measures were developed and subjected to factor analysis: The monitoring and feedback attitudes scale (MFA), measuring general attitudes toward monitoring and feedback, and the attitudes toward standardized assessment scales-monitoring and feedback (ASA-MF), measuring attitudes toward standardized progress tools. Both measures showed good fit to their final factor solutions, with excellent internal consistency for all subscales. Scores on the MFA subscales (Benefit, Harm) indicated that clinicians hold generally positive attitudes toward monitoring and feedback, but scores on the ASA-MF subscales (Clinical Utility, Treatment Planning, Practicality) were relatively neutral. Providers with cognitive-behavioral theoretical orientations held more positive attitudes. Only 13.9 % of clinicians reported using standardized progress measures at least monthly and 61.5 % never used them. Providers with more positive attitudes reported higher use, providing initial support for the predictive validity of the ASA-MF and MFA. Thus, while clinicians report generally positive attitudes toward monitoring and feedback, routine collection of standardized progress measures remains uncommon. Implications for the dissemination and implementation of monitoring and feedback systems are discussed.
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Affiliation(s)
- Amanda Jensen-Doss
- Child Division, Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA.
| | - Emily M Becker Haimes
- Child Division, Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | - Ashley M Smith
- Child Division, Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | | | - Cara C Lewis
- University of Washington, Seattle, USA
- Indiana University, Bloomington, USA
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25
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Livet M, Yannayon M, Sheppard K, Kocher K, Upright J, McMillen J. Exploring Provider Use of a Digital Implementation Support System for School Mental Health: A Pilot Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 45:362-380. [PMID: 28993929 DOI: 10.1007/s10488-017-0829-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This pilot study explored provider use of an online system, Centervention, to support the delivery of empirically supported school-based mental health interventions (ESIs); and associations between components of this system [resources, training, technical assistance (TA), feedback loops], implementation indicators, and student outcomes. Multilevel modeling data were collected from 39 providers implementing ESIs with 758 students. Training, TA, and progress monitoring predicted ESI adherence, and perceived value of resources and TA influenced student responsiveness. Greater adherence was predictive of better socio-emotional outcomes. Interviews with 15 providers illuminated how they used these four Centervention support strategies. Implications for digital implementation support research are discussed.
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Affiliation(s)
- Melanie Livet
- 3C Institute, 4364 S Alston Ave, Durham, NC, 27713, USA.
| | - Mary Yannayon
- 3C Institute, 4364 S Alston Ave, Durham, NC, 27713, USA
| | - Kelly Sheppard
- University of North Carolina-Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Kelly Kocher
- 3C Institute, 4364 S Alston Ave, Durham, NC, 27713, USA
| | - James Upright
- 3C Institute, 4364 S Alston Ave, Durham, NC, 27713, USA
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26
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Lyon AR, Pullmann MD, Whitaker K, Ludwig K, Wasse JK, McCauley E. A Digital Feedback System to Support Implementation of Measurement-Based Care by School-Based Mental Health Clinicians. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 48:S168-S179. [PMID: 28278597 DOI: 10.1080/15374416.2017.1280808] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Evidence supports the utility of measurement-based care (MBC) to improve youth mental health outcomes, but clinicians rarely engage in MBC practices. Digital measurement feedback systems (MFS) may reflect a feasible strategy to support MBC adoption and sustainment. This pilot study was initiated to evaluate the impact of a MFS and brief consultation supports to facilitate MBC uptake and sustainment among mental health clinicians in the education sector, the most common mental health service delivery setting for youth. Following an initial training in MBC, 14 clinicians were randomized to either a digital MFS and brief consultation supports or control. Baseline ratings of MBC attitudes, skill, and use were collected. In addition, daily assessment ratings tracked 2 core MBC practices (i.e., assessment tool administration, provision of feedback) over a 6-month follow-up period. Clinicians in the MFS condition demonstrated rapid increases in both MBC practices, whereas the control group did not significantly change. For clinicians in the MFS group, consultation effects were significant for feedback and approached significance for administration. Over the follow-up period, average decreases in the current study were moderate with only 1 of the 2 outcome variables (administration) decreasing significantly. Inspection of individual clinician trajectories revealed substantial within-group trend variation. MFS may represent an effective MBC implementation strategy beyond initial training, although individual clinician response is variable. Identifying feasible and impactful implementation strategies is critical given the ability of MBC to support precision health care.
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Affiliation(s)
- Aaron R Lyon
- a Department of Psychiatry and Behavioral Health Sciences , University of Washington
| | - Michael D Pullmann
- a Department of Psychiatry and Behavioral Health Sciences , University of Washington
| | - Kelly Whitaker
- a Department of Psychiatry and Behavioral Health Sciences , University of Washington
| | - Kristy Ludwig
- a Department of Psychiatry and Behavioral Health Sciences , University of Washington
| | | | - Elizabeth McCauley
- a Department of Psychiatry and Behavioral Health Sciences , University of Washington
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27
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Advancing Evidence-Based Assessment in School Mental Health: Key Priorities for an Applied Research Agenda. Clin Child Fam Psychol Rev 2016; 19:271-284. [PMID: 27730441 DOI: 10.1007/s10567-016-0217-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28
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Lyon AR, Whitaker K, French WP, Richardson LP, Wasse JK, McCauley E. Collaborative Care in Schools: Enhancing Integration and Impact in Youth Mental Health. ADVANCES IN SCHOOL MENTAL HEALTH PROMOTION 2016; 9:148-168. [PMID: 28392832 PMCID: PMC5383210 DOI: 10.1080/1754730x.2016.1215928] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Collaborative Care is an innovative approach to integrated mental health service delivery that focuses on reducing access barriers, improving service quality, and lowering healthcare expenditures. A large body of evidence supports the effectiveness of Collaborative Care models with adults and, increasingly, for youth. Although existing studies examining these models for youth have focused exclusively on primary care, the education sector is also an appropriate analog for the accessibility that primary care offers to adults. Collaborative Care aligns closely with the practical realities of the education sector and may represent a strategy to achieve some of the objectives of increasingly popular multi-tiered systems of supports frameworks. Unfortunately, no resources exist to guide the application of Collaborative Care models in schools. Based on the existing evidence for Collaborative Care models, the current paper (1) provides a rationale for the adaptation of Collaborative Care models to improve mental health service accessibility and effectiveness in the education sector; (2) presents a preliminary Collaborative Care model for use in schools; and (3) describes avenues for research surrounding school-based Collaborative Care, including the currently funded Accessible, Collaborative Care for Effective School-based Services (ACCESS) project.
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29
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Lyon AR, Wasse JK, Ludwig K, Zachry M, Bruns EJ, Unützer J, McCauley E. The Contextualized Technology Adaptation Process (CTAP): Optimizing Health Information Technology to Improve Mental Health Systems. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 43:394-409. [PMID: 25677251 PMCID: PMC4536193 DOI: 10.1007/s10488-015-0637-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Health information technologies have become a central fixture in the mental healthcare landscape, but few frameworks exist to guide their adaptation to novel settings. This paper introduces the contextualized technology adaptation process (CTAP) and presents data collected during Phase 1 of its application to measurement feedback system development in school mental health. The CTAP is built on models of human-centered design and implementation science and incorporates repeated mixed methods assessments to guide the design of technologies to ensure high compatibility with a destination setting. CTAP phases include: (1) Contextual evaluation, (2) Evaluation of the unadapted technology, (3) Trialing and evaluation of the adapted technology, (4) Refinement and larger-scale implementation, and (5) Sustainment through ongoing evaluation and system revision. Qualitative findings from school-based practitioner focus groups are presented, which provided information for CTAP Phase 1, contextual evaluation, surrounding education sector clinicians' workflows, types of technologies currently available, and influences on technology use. Discussion focuses on how findings will inform subsequent CTAP phases, as well as their implications for future technology adaptation across content domains and service sectors.
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Affiliation(s)
- Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St., Suite 100, Seattle, WA, 98115, USA.
| | | | - Kristy Ludwig
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St., Suite 100, Seattle, WA, 98115, USA
| | - Mark Zachry
- Department of Human Centered Design and Engineering, University of Washington, Seattle, USA
| | - Eric J Bruns
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St., Suite 100, Seattle, WA, 98115, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St., Suite 100, Seattle, WA, 98115, USA
| | - Elizabeth McCauley
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St., Suite 100, Seattle, WA, 98115, USA
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30
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Bruns EJ, Duong MT, Lyon AR, Pullmann MD, Cook CR, Cheney D, McCauley E. Fostering SMART partnerships to develop an effective continuum of behavioral health services and supports in schools. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2016; 86:156-70. [PMID: 26963185 DOI: 10.1037/ort0000083] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The education sector offers compelling opportunities to address the shortcomings of traditional mental health delivery systems and to prevent and treat youth mental, emotional, and behavioral (MEB) problems. Recognizing that social and emotional wellness is intrinsically related to academic success, schools are moving to adopt multi-tier frameworks based on the public health model that provide a continuum of services to all children, including services to address both academic and MEB problems. In this article, we review the potential value of multi-tier frameworks in facilitating access to, and increasing the effectiveness of, mental health services in schools, and review the empirical support for school-based mental health interventions by tier. We go on to describe a community-academic partnership between the Seattle Public Schools and the University of Washington School Mental Health Assessment, Research, and Training (SMART) Center that exemplifies how multi-tier educational frameworks, research and evidence, and purposeful collaboration can combine to improve development and implementation of a range of school-based strategies focused on MEB needs of students. Finally, we present a set of 10 recommendations that may help guide other research and practice improvement efforts to address MEB problems in youth through effective school mental health programming. (PsycINFO Database Record
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Affiliation(s)
- Eric J Bruns
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - Mylien T Duong
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - Michael D Pullmann
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | | | | | - Elizabeth McCauley
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
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Duong MT, Lyon AR, Ludwig K, Wasse JK, McCauley E. Student Perceptions of the Acceptability and Utility of Standardized and Idiographic Assessment in School Mental Health. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2016; 18:19-63. [PMID: 27441029 DOI: 10.1080/14623730.2015.1079429] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Evidence-based assessment (EBA) comprises the use of research and theory to select methods and processes that have demonstrated reliability, validity, and clinical usefulness for prescribed populations. EBA can lead to positive clinical change, and recent work has suggested that it is perceived to be useful by school mental health providers. However, virtually nothing is known about student perceptions of assessment use. Semi-structured interviews were conducted with 31 ethnically diverse middle and high school students (71% female) receiving mental health services in school-based health centers. Findings indicated that the majority of students found assessments to be useful, and perceived three primary functions of assessments: structuring the therapy session, increasing students' self-awareness, and improving communication with the provider. Barriers to acceptability were also found for a minority of respondents. Some students found the nature of standardized assessments to be confining, and others expressed that they wanted more feedback from their counselors about their responses. Idiographic assessments demonstrated especially high acceptability in this sample, with students reporting that tracking idiographic outcomes increased self-awareness, spurred problem-solving, and helped them to reach behavioral goals. Implications for school mental health service improvements are discussed.
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Affiliation(s)
- Mylien T Duong
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Kristy Ludwig
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | | | - Elizabeth McCauley
- Department of Psychiatry and Behavioral Sciences, University of Washington
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The Brief Intervention for School Clinicians (BRISC): A mixed-methods evaluation of feasibility, acceptability, and contextual appropriateness. SCHOOL MENTAL HEALTH 2015; 7:273-286. [PMID: 26688700 DOI: 10.1007/s12310-015-9153-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To maximize impact across the broad spectrum of mental health needs exhibited by youth in school settings, interventions must be designed to be effective, efficient, and demonstrate good fit with the educational context. The current paper reports on the second phase of an iterative development process for a short-term, "Tier 2" intervention for use by school-based mental health providers - the Brief Intervention for School Clinicians (BRISC) - using mixed qualitative and quantitative analyses to evaluate feasibility, acceptability, and appropriateness while emphasizing student experiences. This phase was intended to yield information to drive further protocol refinement and testing across subsequent phases. We describe the rationale for, development of, and formative testing of the BRISC intervention. Results suggest that BRISC may be feasible to deliver, acceptable to students, and appropriate to the school context. In particular, the BRISC process appears to be effective in enhancing student engagement in the intervention and identifying and addressing individualized student needs. These findings and directions for further enhancing BRISC's potential for positive impact highlight how treatment development may benefit from initial, small-scale evaluations focused both on client and implementation outcomes.
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