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Last BS, Kiefer M, Yang Y, Annur A, Dallard N, Schaffer E, Wolk CB. A Mixed Methods Examination of Session Planning Among Public Mental Health Therapists. J Behav Health Serv Res 2024:10.1007/s11414-024-09900-8. [PMID: 39187736 DOI: 10.1007/s11414-024-09900-8] [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: 07/16/2024] [Indexed: 08/28/2024]
Abstract
Session planning is a core activity for implementing evidence-based practices (EBPs), yet it is unknown whether public mental health settings provide the support for therapists to session plan. This two-part study conducted in collaboration with EBP leaders in Philadelphia's public mental health system deployed mixed methods to examine therapists' session planning practices and preferences. In Study 1, 61 public mental health therapists completed an online survey to identify session planning barriers and facilitators, current practices, and desired planning supports. In Study 2, nine therapists who ranked a session planning tool as a top choice support in Study 1 participated in two focus groups to elaborate on their survey responses and provide feedback on three session planning tool prototypes. Study 1 survey respondents cited multi-level barriers and facilitators to session planning. In both closed- and open-ended responses, analyzed descriptively and via content analysis respectively, therapists described wanting more time, lower caseloads, financial incentives for session planning, and additional clinical resources and guidance from trainings, peers, and supervisors to support session planning. Study 2 focus group participants, whose responses were analyzed using content analysis, reiterated the need for these multi-level supports and expressed the need for a "one-stop" database of session planning tools that would be free, easily searchable, and modifiable for varied clinical needs. All three session planning tool prototypes reviewed were acceptable; two were also considered feasible and appropriate. This investigation of an under-studied aspect of the EBP implementation process reveals the need for multi-level session planning supports.
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Affiliation(s)
- Briana S Last
- Department of Psychology, Stony Brook University, Psychology Building B, Room 358, Stony Brook, NY, 11794, USA.
| | - Madeline Kiefer
- Department of Psychology, Stony Brook University, Psychology Building B, Room 358, Stony Brook, NY, 11794, USA
| | - Yuanyuan Yang
- Department of Psychology, Stony Brook University, Psychology Building B, Room 358, Stony Brook, NY, 11794, USA
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Ahnaf Annur
- Department of Psychology, Stony Brook University, Psychology Building B, Room 358, Stony Brook, NY, 11794, USA
| | | | | | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Mirzaian CB, Deavenport-Saman A, Hudson SM, Betz CL. Barriers to Mental Health Care Transition for Youth and Young Adults with Intellectual and Developmental Disabilities and Co-occurring Mental Health Conditions: Stakeholders' Perspectives. Community Ment Health J 2024; 60:1104-1116. [PMID: 38619698 PMCID: PMC11199219 DOI: 10.1007/s10597-024-01262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/25/2024] [Indexed: 04/16/2024]
Abstract
Youth and young adults (YYA) with intellectual and developmental disabilities (IDD) have high rates of co-occurring mental health (MH) conditions. The time during transition from pediatric to adult health and mental health care can be a very challenging, with risk of loss of services leading to poor outcomes. This study aimed to explore barriers to transition from pediatric to adult health and mental health care and services for individuals with IDD and co-occurring MH conditions, by eliciting the view of stakeholders, including disability advocates. Qualitative analysis was conducted using grounded theory, and themes were coded based upon the social-ecological model (SEM). We generated themes into multiple levels: the individual level, the family level, the provider level, the systems of care level, and the societal level. Stakeholders expressed a critical need to improve coordination between systems, and to increase provider availability to care for YYA with IDD and co-occurring MH conditions.
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Affiliation(s)
- Christine B Mirzaian
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA.
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Alexis Deavenport-Saman
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Sharon M Hudson
- AltaMed Institute for Health Equity, AltaMed Health Services, Los Angeles, CA, USA
| | - Cecily L Betz
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Kruger DJ, Kirk HM, Leonard KE, Lynch JJ, Nielsen N, Collins RL, Ditre JW, Fletcher-Blake D, Green SA, Hogue A, Hunter JK, Marraffa JM, Clemency BM. Assessing experts' perspectives on challenges in substance misuse prevention, harm reduction, and treatment to shape funding priorities in New York State. Harm Reduct J 2024; 21:134. [PMID: 39004729 PMCID: PMC11247824 DOI: 10.1186/s12954-024-01045-3] [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: 03/28/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Drug overdose is a leading cause of death and opioid-related deaths increased by more than 300% from 2010 to 2020 in New York State. Experts holding a range of senior leadership positions from across New York State were asked to identify the greatest challenges in substance misuse prevention, harm reduction, and treatment continuum of care. Expert input was used to shape funding priorities. METHOD Individual semi-structured interviews of sixteen experts were conducted in April and May 2023. Experts included academics, medical directors, leaders of substance misuse service agencies, administrators of a state agency, a county mental health commissioner, the president of a pharmacy chain, and a senior vice president of an addiction-related national non-profit. Zoom interviews were conducted individually by an experienced qualitative interviewer and were recorded, transcribed, and coded for content. An initial report, with the results of the interviews organized by thematic content, was reviewed by the research team and emailed to the expert interviewees for feedback. RESULTS The research team identified five major themes: 1. Siloed and fragmented care delivery systems; 2. Need for a skilled workforce; 3. Attitudes towards addiction (stigma); 4. Limitations in treatment access; and 5. Social and drug related environmental factors. Most experts identified challenges in each major theme; over three-quarters identified issues related to siloed and fragmented systems and the need for a skilled workforce. Each expert mentioned more than one theme, three experts mentioned all five themes and six experts mentioned four themes. CONCLUSIONS Research, educational, and programmatic agendas should focus on identified topics as a means of improving the lives of patients at risk for or suffering from substance use-related disorders. The results of this project informed funding of pilot interventions designed to address the identified care challenges.
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Affiliation(s)
- Daniel J Kruger
- Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, University at Buffalo Gateway Building, Suite 420, 77 Goodell St., Buffalo, NY, 14203, USA.
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY, 14214, USA.
- Clinical and Research Institute On Addictions, University at Buffalo, 1021 Main St, Buffalo, NY, 14203, USA.
| | - Hilary M Kirk
- Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, University at Buffalo Gateway Building, Suite 420, 77 Goodell St., Buffalo, NY, 14203, USA
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY, 14214, USA
| | - Kenneth E Leonard
- Clinical and Research Institute On Addictions, University at Buffalo, 1021 Main St, Buffalo, NY, 14203, USA
| | - Joshua J Lynch
- Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, University at Buffalo Gateway Building, Suite 420, 77 Goodell St., Buffalo, NY, 14203, USA
- Clinical and Research Institute On Addictions, University at Buffalo, 1021 Main St, Buffalo, NY, 14203, USA
| | - Nancy Nielsen
- Clinical and Research Institute On Addictions, University at Buffalo, 1021 Main St, Buffalo, NY, 14203, USA
| | - R Lorraine Collins
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY, 14214, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA
| | | | - Susan A Green
- School of Social Work, University at Buffalo, 85 Baldy Hall, Buffalo, NY, 14260, USA
| | - Aaron Hogue
- Partnership to End Addiction, 711 Third Avenue, 5Th Floor, Suite 500, New York, NY, 10017, USA
| | - Julia K Hunter
- United Health Services Hospitals, Inc., 10-42 Mitchell Ave, Binghamton, NY, 13903, USA
| | - John M Marraffa
- Kinney Drugs, 6333 Route 298, Suite 305, Syracuse, NY, 13057, USA
| | - Brian M Clemency
- Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, University at Buffalo Gateway Building, Suite 420, 77 Goodell St., Buffalo, NY, 14203, USA
- Clinical and Research Institute On Addictions, University at Buffalo, 1021 Main St, Buffalo, NY, 14203, USA
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Bass E, Salyers MP, Hall A, Garabrant J, Morse G, Kyere E, Dell N, Greenfield J, Fukui S. Why do Stayers Stay? Perceptions of White and Black Long-Term Employees in a Community Mental Health Center. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01387-x. [PMID: 38850384 DOI: 10.1007/s10488-024-01387-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: 05/14/2024] [Indexed: 06/10/2024]
Abstract
Previous research has focused on factors influencing turnover of employees in the mental health workforce, yet little research has explored reasons why employees stay. To facilitate retaining a diverse mental health workforce, the current study aimed to elucidate factors that contributed to employees' tenure at a community mental health center (CHMC) as well as compare these perceptions between Black and White employees. Long-term employees (7 years or more) from one urban CMHC (n = 22) completed semi-structured stayer interviews. Using emergent thematic analysis, stayer interviews revealed four major themes for why they have stayed at the organization for 7 years or more: (1) work as a calling, (2) supportive relationships, (3) opportunities for growth or meaningful contribution, and (4) organization mission's alignment with personal attributes or values. Comparison between Black and White stayer narratives revealed differences in their perceptions with work as a calling and opportunities for growth and meaningful contribution. Guided by themes derived from stayer interviews, the current study discusses theoretical (e.g., job embeddedness theory, theory of racialized organizations, self-determination theory) and practical implications (e.g., supporting job autonomy, Black voices in leadership) in an effort to improve employee retention and address structural racism within a mental health organization.
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Affiliation(s)
- Emily Bass
- Department of Psychology, Indiana University-Purdue University at Indianapolis, 402 N. Blackford St, Indianapolis, IN, 46202, USA.
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University at Indianapolis, 402 N. Blackford St, Indianapolis, IN, 46202, USA
| | - Ashton Hall
- Department of Psychology, Indiana University-Purdue University at Indianapolis, 402 N. Blackford St, Indianapolis, IN, 46202, USA
| | - Jennifer Garabrant
- Department of Psychology, Indiana University-Purdue University at Indianapolis, 402 N. Blackford St, Indianapolis, IN, 46202, USA
| | - Gary Morse
- Places for People, Inc, St. Louis, MO, USA
| | - Eric Kyere
- School of Social Work, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Nathaniel Dell
- Places for People, Inc, St. Louis, MO, USA
- Division of Addiction Science, Prevention, and Treatment, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jaime Greenfield
- Places for People, Inc, St. Louis, MO, USA
- BJC Healthcare, St. Louis, MO, USA
| | - Sadaaki Fukui
- School of Social Work, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
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D'Adamo L, Laboe A, Goldberg J, Howe C, Fennig M, DePietro B, Firebaugh ML, Cooper Z, Wilfley D, Fitzsimmons-Craft E. Development and usability testing of an online platform for provider training and implementation of cognitive-behavioral therapy guided self-help for eating disorders. RESEARCH SQUARE 2024:rs.3.rs-4409969. [PMID: 38854104 PMCID: PMC11160899 DOI: 10.21203/rs.3.rs-4409969/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background Most individuals with eating disorders (EDs) do not receive treatment, and those who do receive care typically do not receive evidence-based treatment, partly due to lack of accessible provider training. This study developed a novel "all-in-one" online platform for disseminating training for mental health providers in cognitive-behavioral therapy guided self-help (CBTgsh) for EDs and supporting its implementation. The aim of the study was to obtain usability data from the online platform prior to evaluating its effects on provider training outcomes and patient ED symptom outcomes in an open pilot trial. Methods Nine mental health provider participants (n = 4 in Cycle 1; n = 5 in Cycle 2) and 9 patient participants (n = 4 in Cycle 1; n = 5 in Cycle 2) were enrolled over two cycles of usability testing. In Cycle 1, we recruited providers and patients separately to complete brief platform testing sessions. In Cycle 2, we recruited provider-patient dyads; providers completed training using the platform and subsequently delivered CBTgsh to a patient for three weeks. Usability was assessed using the System Usability Scale (SUS), the Usefulness, Satisfaction, and Ease of Use Questionnaire (USE), and semi-structured interviews. Results Interview feedback converged on two themes for providers (applicability of program for real-world use, platform structure and function) and two themes for patients (barriers and facilitators to engagement, perceived treatment effects). SUS and USE scores were in the "average" to "good" ranges across cycles. Conclusions Findings from this study demonstrate preliminary feasibility and acceptability of the online platform. Data collected in this study will inform further refinements to the online platform. The platform's effects on provider training outcomes and patient ED symptom outcomes will be evaluated in an open pilot trial. Given the wide treatment gap for EDs and barriers to dissemination and implementation of evidence-based treatments, the online platform represents a scalable solution that could improve access to evidence-based care for EDs.
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Webb EL, Ireland JL, Lewis M, Morris D. Potential Sources of Moral Injury for Healthcare Workers in Forensic and Psychiatric Settings: A Systematic Review and Meta-ethnography. TRAUMA, VIOLENCE & ABUSE 2024; 25:918-934. [PMID: 37083056 PMCID: PMC10913356 DOI: 10.1177/15248380231167390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The current research examines potentially morally injurious events (PMIEs) faced by healthcare professionals working in forensic and psychiatric environments. A systematic literature review was conducted to identify peer-reviewed articles reporting on sources of moral injury or similar concepts (e.g., moral distress) for healthcare workers in such settings. Thirty articles were included and analyzed using a meta-ethnographic approach. Synthesis yielded three third-order factors, each reflecting a moral dichotomy: (a) "between profession and system," (b) "between relations with patients and relations with others," and (c) "between principles and practices." Findings illustrated the hierarchical relationships between dichotomies, with discordance between values of the healthcare profession and features of the healthcare system providing the conditions for PMIEs to occur. The review advances conceptual understandings of PMIEs in forensic and psychiatric settings, illustrating the multilayered dimensions within which morally injurious events are experienced. Theoretical and practical implications are offered that may support the early detection and prevention of moral injury in healthcare professionals.
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Affiliation(s)
- Elanor Lucy Webb
- Centre for Developmental and Complex Trauma, St Andrew’s Healthcare, Northampton, UK
| | - Jane L. Ireland
- University of Central Lancashire, Preston, UK
- Ashworth Research Centre, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Michael Lewis
- University of Central Lancashire, Preston, UK
- Ashworth Research Centre, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Deborah Morris
- Centre for Developmental and Complex Trauma, St Andrew’s Healthcare, Northampton, UK
- University of Buckingham, UK
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Facente SN, Humphrey JL, Akiba C, Patel SV, Wenger LD, Tookes H, Bluthenthal RN, LaKosky P, Prohaska S, Morris T, Kral AH, Lambdin BH. Funding and Delivery of Syringe Services Programs in the United States, 2022. Am J Public Health 2024; 114:435-443. [PMID: 38478864 PMCID: PMC10937606 DOI: 10.2105/ajph.2024.307583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 03/17/2024]
Abstract
Objectives. To describe the current financial health of syringe services programs (SSPs) in the United States and to assess the predictors of SSP budget levels and associations with delivery of public health interventions. Methods. We surveyed all known SSPs operating in the United States from February to June 2022 (n = 456), of which 68% responded (n = 311). We used general estimating equations to assess factors influencing SSP budget size and estimated the effects of budget size on multiple measures of SSP services. Results. The median SSP annual budget was $100 000 (interquartile range = $20 159‒$290 000). SSPs operating in urban counties and counties with higher levels of opioid overdose mortality had significantly higher budget levels, while SSPs located in counties with higher levels of Republican voting in 2020 had significantly lower budget levels. SSP budget levels were significantly and positively associated with syringe and naloxone distribution coverage. Conclusions. Current SSP funding levels do not meet minimum benchmarks. Increased funding would help SSPs meet community health needs. Public Health Implications. Federal, state, and local initiatives should prioritize sustained SSP funding to optimize their potential in addressing multiple public health crises. (Am J Public Health. 2024;114(4):435-443. https://doi.org/10.2105/AJPH.2024.307583).
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Affiliation(s)
- Shelley N Facente
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Jamie L Humphrey
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Christopher Akiba
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Sheila V Patel
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Lynn D Wenger
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Hansel Tookes
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Ricky N Bluthenthal
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Paul LaKosky
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Stephanie Prohaska
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Terry Morris
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Alex H Kral
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Barrot H Lambdin
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
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Jumper MBE, Friedman BR, Becker-Haimes EM, Dong F, Kohler CG, Hurford I, Calkins ME. Implementation of an Adapted Fidelity Scale for Pennsylvania Coordinated Specialty Care Programs for First Episode Psychosis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:421-435. [PMID: 37943446 DOI: 10.1007/s11121-023-01607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/10/2023]
Abstract
Coordinated Specialty Care (CSC) is an evidence-based model for early intervention of first episode psychosis (FEP). Monitoring fidelity to CSC models is essential for proper evaluation of program outcomes and quality improvement. To address variability across CSC programs and fidelity assessment-associated burden, an adapted fidelity scale was developed and implemented statewide in Pennsylvania. This report describes the design and preliminary performance of the adapted scale. The Pennsylvania FEP Fidelity Scale (PA-FEP-FS) assesses adherence to the CSC model by focusing on essential model components of other established fidelity scales, in tandem with program evaluation data. Initial data from fourteen PA-FEP sites from 2018 to 2021 were examined as preliminary validation. Assessment-associated burdens and costs were also estimated. PA-FEP-FS captured essential components of CSC models and proved feasible for implementation across varying program structures, while minimizing burden and cost. Programs utilized annual feedback as CSC benchmarks, evidenced by increased scores over time. PA-FEP-FS provides a model for adapting CSC fidelity scales to meet state- or local-level requirements while reducing assessment burdens and costs that may be associated with existing scales.
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Affiliation(s)
- Megan B E Jumper
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Bess Rose Friedman
- Division of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Emily M Becker-Haimes
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Fanghong Dong
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Christian G Kohler
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Irene Hurford
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Monica E Calkins
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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Sripada RK, Grau PP, Porath BR, Burgess J, Van T, Kim HM, Boden MT, Zivin K. Role of Institutional Support for Evidence-Based Psychotherapy in Satisfaction and Burnout Among Veterans Affairs Therapists. Psychiatr Serv 2024; 75:206-213. [PMID: 37880969 DOI: 10.1176/appi.ps.20230086] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Burnout is widespread among psychotherapists and leads to negative mental and other health outcomes, absenteeism, and turnover. Job resources, including institutional support for evidence-based practices, can buffer against burnout and may improve satisfaction among therapists. The Veterans Health Administration (VHA) is the nation's largest integrated health system and employs 23,000 therapists, including psychologists, social workers, and counselors. The authors assessed associations between perceived institutional support for evidence-based treatment and satisfaction and burnout among VHA therapists. METHODS This analysis used data from the VHA's national 2018 Mental Health Provider Survey. Responding therapists (N=5,341) answered questions about the quality of mental health care and job satisfaction. Multilevel logistic regression models were used to predict burnout and satisfaction. The authors tested availability of evidence-based treatment and measurement-based care (MBC) as predictors; analyses were adjusted for therapist workload, demographic characteristics, and potential clustering by facility. RESULTS VHA therapists had less burnout and more job satisfaction when they perceived receiving institutional support for evidence-based psychotherapy (EBP) and MBC, irrespective of whether the analyses were adjusted for workload. Less difficulty in scheduling EBP was significantly associated with decreased likelihood of burnout (OR=0.83, p<0.001) and increased satisfaction (OR=1.09, p=0.008). Less difficulty ending psychotherapy was significantly associated with decreased likelihood of burnout (OR=0.89, p=0.002) and increased satisfaction (OR=1.12, p=0.004). CONCLUSIONS Support for evidence-based practices, including EBP and MBC, was closely linked to VHA therapists' satisfaction and burnout. Expanding support for therapists to provide evidence-based treatment may benefit therapists, patients, and the health care system.
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Affiliation(s)
- Rebecca K Sripada
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Sripada, Grau, Porath, Burgess, Van, Kim, Zivin); Department of Psychiatry, Michigan Medicine (Sripada, Grau, Zivin), and Consulting for Statistics, Computing and Analytics Research (Kim), University of Michigan, Ann Arbor; Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden)
| | - Peter P Grau
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Sripada, Grau, Porath, Burgess, Van, Kim, Zivin); Department of Psychiatry, Michigan Medicine (Sripada, Grau, Zivin), and Consulting for Statistics, Computing and Analytics Research (Kim), University of Michigan, Ann Arbor; Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden)
| | - Brittany R Porath
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Sripada, Grau, Porath, Burgess, Van, Kim, Zivin); Department of Psychiatry, Michigan Medicine (Sripada, Grau, Zivin), and Consulting for Statistics, Computing and Analytics Research (Kim), University of Michigan, Ann Arbor; Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden)
| | - Jennifer Burgess
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Sripada, Grau, Porath, Burgess, Van, Kim, Zivin); Department of Psychiatry, Michigan Medicine (Sripada, Grau, Zivin), and Consulting for Statistics, Computing and Analytics Research (Kim), University of Michigan, Ann Arbor; Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden)
| | - Tony Van
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Sripada, Grau, Porath, Burgess, Van, Kim, Zivin); Department of Psychiatry, Michigan Medicine (Sripada, Grau, Zivin), and Consulting for Statistics, Computing and Analytics Research (Kim), University of Michigan, Ann Arbor; Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden)
| | - H Myra Kim
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Sripada, Grau, Porath, Burgess, Van, Kim, Zivin); Department of Psychiatry, Michigan Medicine (Sripada, Grau, Zivin), and Consulting for Statistics, Computing and Analytics Research (Kim), University of Michigan, Ann Arbor; Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden)
| | - Matthew T Boden
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Sripada, Grau, Porath, Burgess, Van, Kim, Zivin); Department of Psychiatry, Michigan Medicine (Sripada, Grau, Zivin), and Consulting for Statistics, Computing and Analytics Research (Kim), University of Michigan, Ann Arbor; Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden)
| | - Kara Zivin
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Sripada, Grau, Porath, Burgess, Van, Kim, Zivin); Department of Psychiatry, Michigan Medicine (Sripada, Grau, Zivin), and Consulting for Statistics, Computing and Analytics Research (Kim), University of Michigan, Ann Arbor; Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden)
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10
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Kuckertz M, Lind T, Lau AS, Motamedi M, Wright B, Le K, Brookman-Frazee L. Outside the Clinic Door: How Neighborhood Sociodemographic Disadvantage is Associated with Community Therapist Secondary Traumatic Stress and Emotional Exhaustion. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2024; 9:15-32. [PMID: 38435098 PMCID: PMC10906964 DOI: 10.1080/23794925.2024.2310512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Therapists serving families with high rates of trauma exposure in community mental health clinics face the potential risk of experiencing secondary traumatic stress and emotional exhaustion, both of which pose barriers for the implementation and sustainment of evidence-based practices. Previous research documents negative effects of living in socioeconomic disadvantaged neighborhoods on child development but has not examined the effects of working in these neighborhoods on therapist well-being. The current study merges publicly available data, administrative claims data on mental health services, and therapy survey data to 1) identify associations between neighborhood sociodemographic disadvantage and two community therapist well-being constructs, specifically secondary traumatic stress and emotional exhaustion; and 2) examine potential clinic- and therapist-level explanatory factors in the associations between neighborhood sociodemographic disadvantage and therapist well-being. A cumulative risk index approach was applied to calculate neighborhood sociodemographic disadvantage. Greater neighborhood sociodemographic disadvantage was significantly associated with higher levels of therapist secondary traumatic stress (B=.09, p<.05) but not emotional exhaustion. Because therapists in higher risk neighborhoods face higher secondary traumatic stress levels, additional research is needed to better understand how these therapists can be best supported; thus, supporting families receiving treatment and implementation of evidence-based practices.
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Affiliation(s)
- Mary Kuckertz
- Department of Psychology, Arizona State University, Tempe,
AZ
| | - Teresa Lind
- Department of Child and Family Development, San Diego State
University, San Diego, CA
- Child and Adolescent Services Research Center (CASRC), San
Diego, CA
| | - Anna S. Lau
- Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | - Mojdeh Motamedi
- Child and Adolescent Services Research Center (CASRC), San
Diego, CA
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Blanche Wright
- Department of Health Policy and Management, University of California Los Angeles, Los Angeles, CA
- RAND Corporation, Santa Monica, CA
| | - Kenny Le
- Department of Psychology, University of South Florida,
Tampa, FL
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center (CASRC), San
Diego, CA
- Department of Psychiatry, University of California San Diego, San Diego, CA
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11
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Jensen-Doss A, Woodard G, Patel-Syed Z, Ehrenreich-May J, Rosenfield D, Ginsburg GS. External and Internal Validity Considerations in Youth Effectiveness Trials: Lessons Learned from the COMET Study. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:735-749. [PMID: 37947431 PMCID: PMC10655847 DOI: 10.1080/15374416.2023.2272958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Effectiveness trials aim to increase the generalizability and public health impact of interventions. However, challenges associated with this design present threats to external and internal validity. This paper illustrates these challenges using data from a two-site randomized effectiveness trial, the Community Study of Outcome Monitoring for Emotional Disorders in Teens (COMET) and presents recommendations for future research. METHOD COMET was a randomized effectiveness trial conducted in 19 community mental health clinics in two states comparing three interventions: treatment as usual (TAU), TAU with measurement-based care (TAU+), and the Unified Protocol forTransdiagnostic Treatment of Emotional Disorders in Adolescents with MBC (UPA). Participants included 176 clinicians (mean age = 35.5; 85.8% cisgender female; 53.0% racially and/or ethnically minorized) and 196 adolescents (mean age = 14.7; 65.3% cisgender female; 69.4% racially and/or ethnically minorized). Analyses outlined participant flow from recruitment to study completion, described participant characteristics, and examined site differences. RESULTS Analysis of participant flow suggested that recruitment and retention of clinicians and adolescents was challenging, raising questions about whether participants were representative of participating clinics. Both the clinician and adolescent samples were racially and ethnically diverse and adolescents were low income and clinically complex. Significant site differences were observed in clinician and adolescent characteristics. CONCLUSIONS While this study was successful in recruiting a diverse and historically under-represented sample, difficulties in recruitment and retention raise questions about external validity and site differences present challenges to internal validity of study findings. Suggestions for future effectiveness studies, drawing from implementation science approaches, are discussed.
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Affiliation(s)
| | - Grace Woodard
- University of Miami Department of Psychology, Coral Gables, FL, USA
| | - Zabin Patel-Syed
- Northwestern University Fienberg School of Medicine, Center for Dissemination and Implementation Science, Chicago, IL, USA
| | | | | | - Golda S. Ginsburg
- University of Connecticut School of Medicine, Department of Psychiatry, Farmington, CT, USA
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12
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Motamedi M, Lau AS, Byeon YV, Yu SH, Brookman-Frazee L. Supporting Emotionally Exhausted Community Mental Health Therapists in Appropriately Adapting EBPs for Children and Adolescents. J Behav Health Serv Res 2023; 50:468-485. [PMID: 37430134 DOI: 10.1007/s11414-023-09844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/12/2023]
Abstract
Evidence-based practices (EBPs) are often adapted during community implementation to improve EBP fit for clients and the service context. Augmenting EBPs with additional dosing and content may improve fit. However, reducing EBP content can reduce EBP effectiveness. Using multilevel regression models, this study examined whether supportive program climate and program-furnished EBP-specific implementation strategies (e.g., materials, ongoing training, in-house experts) are associated with augmenting and reducing adaptations, and whether therapist emotional exhaustion moderated these associations. Data were collected from surveys completed by 439 therapists from 102 programs 9 years after a system-driven EBP implementation initiative. Supportive program climate was associated with more augmenting adaptations. Emotional exhaustion was a significant moderator. When organizations used more EBP-specific implementation strategies, more emotionally exhausted therapists reduced EBPs less and less emotionally exhausted therapists augmented EBPs more. Findings provide guidance on how organizations can support appropriate EBP adaptations in spite of therapist emotional exhaustion.
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Affiliation(s)
- Mojdeh Motamedi
- University of California San Diego, La Jolla, USA.
- Child and Adolescent Services Research Center, San Diego, USA.
| | - Anna S Lau
- University of California Los Angeles, Los Angeles, USA
| | | | | | - Lauren Brookman-Frazee
- University of California San Diego, La Jolla, USA
- Child and Adolescent Services Research Center, San Diego, USA
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13
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Brown C, Lerner M, Stadheim J, Kerns C, Moskowitz L, Cohn E, Drahota A, Soorya L, Wainer A. Provider Self-Reported Use and Usefulness of Intervention Strategies for Externalizing Behaviors in Youths with ASD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023:1-15. [PMID: 37706638 PMCID: PMC10937329 DOI: 10.1080/15374416.2023.2251163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To examine predictors of implementation and perceived usefulness of four empirically supported strategies for treating externalizing behavior in youths with ASD. METHOD Participants were 557 providers in the United States with experience treating externalizing behavior in youths with ASD. Generalized estimating equations were used to determine whether self-reported use and usefulness of four empirically supported intervention strategies (functional communication training, functional behavior analysis, visual tools/supports, token economy) were predicted by key provider characteristics: professional discipline, experience, and practice specialization (across three indices) in ASD. Post-hoc contrasts were performed to identify provider groups reporting the greatest use and usefulness of the four strategies. RESULTS Strategies were most often used by providers with behavioral backgrounds, though perceived usefulness of strategies varied by providers' professional discipline. Compared to providers with more than 10 years of experience, less experienced providers endorsed the highest average use and usefulness of almost all strategies. Regarding ASD practice specialization, a lower volume of ASD cases, treating fewer youths with ASD over a 5-year period, and having a higher proportion of practice time working with youths with ASD reported were associated with greater use and usefulness of the strategies. CONCLUSIONS Empirically supported strategies are widely used by and perceived as useful by providers who treat youths with ASD and co-occurring externalizing behaviors. Use and usefulness varies based on provider discipline, experience, and ASD practice specialization.
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Affiliation(s)
| | | | - Jenna Stadheim
- Department of Educational Psychology, University of Nebraska-Lincoln
| | - Connor Kerns
- Department of Psychology, University of British Columbia
| | | | - Elizabeth Cohn
- Hunter-Bellevue School of Nursing, City University of New York
| | - Amy Drahota
- Department of Psychology, Michigan State University
| | - Latha Soorya
- Department of Psychiatry, Rush University Medical Center
| | - Allison Wainer
- Department of Psychiatry, Rush University Medical Center
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14
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John JR, Thavalingam V, Tye M, Dean K, Barzman D, Sorter M, Lin PI. Appraising risk factors of aggression in children and adolescents at psychiatric inpatient units. Psychiatry Res 2023; 327:115368. [PMID: 37506586 DOI: 10.1016/j.psychres.2023.115368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/26/2023] [Accepted: 07/23/2023] [Indexed: 07/30/2023]
Abstract
This study examined predictors of aggression and assessed whether different subgroups of children and young people (CYP) display varying risks of aggressive incidents during hospitalization. Data from 10,090 children admitted to the psychiatric inpatient units of Cincinnati Children's Hospital between April 2010 and June 2021 were analysed. Multivariable logistic regression models were used to determine significant predictors associated with aggression, followed by average marginal effects and cluster analyses to rank and establish clusters by the order of predictor importance. About 32.5% reported positive history of an aggressive incident. The mean BRACHA score was doubled compared to those without a prior history. The primary analysis showed that both younger and male CYPs had higher odds of aggressive incidents. We also found that CYP with an African descent, not being able to live with both biological parents, those who reported positive history of psychiatric hospitalisation, and prior externalising behaviours had higher odds of aggressive incidents. These findings have important clinical and public health implications, as they provide valuable knowledge for healthcare professionals to improve prevention strategies for aggression amongst this vulnerable population.
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Affiliation(s)
- James Rufus John
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Vignesh Thavalingam
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Michelle Tye
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, Australia
| | - Kimberlie Dean
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Justice Health and Forensic Mental Health Network, Sydney, NSW, Australia
| | - Drew Barzman
- Department of Psychiatry and Behavioural Neuroscience, University of Cincinnati, Ohio, United States; Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Ohio, United States
| | - Michael Sorter
- Department of Psychiatry and Behavioural Neuroscience, University of Cincinnati, Ohio, United States; Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Ohio, United States
| | - Ping-I Lin
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; Department of Mental Health, School of Medicine, Western Sydney University, Penrith, NSW, Australia.
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15
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Nayak SS, Scoglio AAJ, Nandi S, Anderson K, Mirand D, Roper K, Méndez-Peñate L, Moulin C, Arty M, Molnar BE. Implementing Integrated Early Childhood Mental Health Services in Primary Care: Relationships, Vision, and Sustainability. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:763-772. [PMID: 37273121 PMCID: PMC10359204 DOI: 10.1007/s10488-023-01275-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/06/2023]
Abstract
The Massachusetts Multi-City Young Children's System of Care Project was a federally funded program to provide integrated early childhood mental health (ECMH) services in primary care for families of very young children (birth-six years old) with Serious Emotional Disturbances across three cities in Massachusetts, U.S.A. This study describes lessons learned from the implementation of this program and makes recommendations for best practices to improve the delivery and efficacy of ECMH services in primary care settings. Staff and leadership (n = 35) from 11 agencies (primary care practices, community service agencies, and local health departments) that co-implemented this program participated in focus groups and semi-structured key informant interviews. Thematic analysis was used to characterize specific facilitators and barriers to successfully implementing system-wide programming for ECMH. Four main themes were identified: (1) Strong multilevel working relationships are critical for integration, (2) Capacity-building activities can be leveraged to improve implementation, (3) Financial challenges are a primary barrier to building efficacious systems of care, and (4) Flexibility and resourcefulness can help overcome logistical challenges in integration. Implementation lessons learned may serve as guidance for other states and institutions in the U.S. seeking to improve the integration of ECMH services into primary care. They may also provide strategies to adapt and scale these interventions to improve the mental health and well-being of young children and their families.
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Affiliation(s)
- Sameera S Nayak
- Department of Sociology, Anthropology, and Public Health, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Arielle A J Scoglio
- Department of Applied and Natural Sciences, Bentley University, Waltham, MA, USA
| | - Shurobhi Nandi
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kayla Anderson
- Institute for Health Equity & Social Justice Research, Northeastern University, 360 Huntington Avenue, Mail Stop INV 314, Boston, MA, 02215, USA
| | - Daphney Mirand
- Institute for Health Equity & Social Justice Research, Northeastern University, 360 Huntington Avenue, Mail Stop INV 314, Boston, MA, 02215, USA
| | - Kate Roper
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Boston, MA, USA
| | - Larisa Méndez-Peñate
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Boston, MA, USA
| | - Christy Moulin
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | - Malika Arty
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | - Beth E Molnar
- Institute for Health Equity & Social Justice Research, Northeastern University, 360 Huntington Avenue, Mail Stop INV 314, Boston, MA, 02215, USA.
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16
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Lyons JS, Fernando AD. Creating the necessary infrastructure for a trauma-informed system of care for children and youth. Front Psychol 2023; 14:1129197. [PMID: 37496789 PMCID: PMC10366599 DOI: 10.3389/fpsyg.2023.1129197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/21/2023] [Indexed: 07/28/2023] Open
Abstract
Understanding and addressing the impact of adverse life events is an important priority in the design of helping systems. However, creating trauma-informed systems requires efforts to embed effective trauma-informed work in routine practice. This article discusses a model for developing trauma-informed systems using the Transformational Collaborative Outcomes Management (TCOM) framework, a strategy for engineering person-centered care. Person-centered care is naturally congruent with trauma-informed care. We describe the initial stages of implementation of a trauma-informed standardized assessment process to support the sustained evolution of trauma-informed care. Distinguishing between traumatic experiences and traumatic stress is fundamental to an effective trauma-informed system. We describe two sets of analyses-one in a statewide child welfare system and the other in a statewide behavioral health system. These projects found opportunities in the analysis of the detection of traumatic stress based on traumatic experiences to inform practice and policy. Being trauma-informed in child welfare is distinct from being trauma-informed in behavioral health. In child welfare, it appears that a number of children are resilient in the face of traumatic experiences and do not require trauma treatment interventions. However, delayed and missed traumatic stress responses are common. In behavioral health, misses often occur among adolescents, particularly boys, who engage in acting out behavior. Opportunities for the ongoing development of trauma-informed systems using the TCOM framework are discussed.
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17
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Fukui S, Wu W, Greenfield J, Salyers MP, Morse G, Garabrant J, Bass E, Kyere E, Dell N. Machine Learning with Human Resources Data: Predicting Turnover among Community Mental Health Center Employees. THE JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS 2023; 26:63-76. [PMID: 37357871 PMCID: PMC10424701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/24/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Human resources (HR) departments collect extensive employee data that can be useful for predicting turnover. Yet, these data are not often used to address turnover due to the complex nature of recorded data forms. AIMS OF THE STUDY The goal of the current study was to predict community mental health center employees' turnover by applying machine learning (ML) methods to HR data and to evaluate the feasibility of the ML approaches. METHODS Historical HR data were obtained from two community mental health centers, and ML approaches with random forest and lasso regression as training models were applied. RESULTS The results suggested a good level of predictive accuracy for turnover, particularly with the random forest model (e.g., Area Under the Curve was above .8) compared to the lasso regression model overall. The study also found that the ML methods could identify several important predictors (e.g., past work years, wage, work hours, age, job position, training hours, and marital status) for turnover using historical HR data. The HR data extraction processes for ML applications were also evaluated as feasible. DISCUSSION The current study confirmed the feasibility of ML approaches for predicting individual employees' turnover probabilities by using HR data the organizations had already collected in their routine organizational management practice. The developed approaches can be used to identify employees who are at high risk for turnover. Because our primary purpose was to apply ML methods to estimate an individual employee's turnover probability given their available HR data (rather than determining generalizable predictors at the wider population level), our findings are limited or restricted to the specific organizations under the study. As ML applications are accumulated across organizations, it may be expected that some findings might be more generalizable across different organizations while others may be more organization-specific (idiographic). IMPLICATIONS FOR HEALTH CARE PROVISION AND USE The organization-specific findings can be useful for the organization's HR and leadership to evaluate and address turnover in their specific organizational contexts. Preventing extensive turnover has been a significant priority for many mental health organizations to maintain the quality of services for clients. IMPLICATIONS FOR HEALTH POLICIES The generalizable findings may contribute to broader policy and workforce development efforts. IMPLICATIONS FOR FURTHER RESEARCH As our continuing research effort, it is important to study how the ML methods and outputs can be meaningfully utilized in routine management and leadership practice settings in mental health (including how to develop organization-tailored intervention strategies to support and retain employees) beyond identifying high turnover risk individuals. Such organization-based intervention strategies with ML applications can be accumulated and shared by organizations, which will facilitate the evidence-based learning communities to address turnover. This, in turn, may enhance the quality of care we can offer to clients. The continuing efforts will provide new insights and avenues to address data-driven, evidence-based turnover prediction and prevention strategies using HR data that are often under-utilized.
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Affiliation(s)
- Sadaaki Fukui
- Indiana University School of Social Work, 902 West New York Street, Indianapolis, IN 46202-5156, USA,
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18
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Broadbent M, Medina Grespan M, Axford K, Zhang X, Srikumar V, Kious B, Imel Z. A machine learning approach to identifying suicide risk among text-based crisis counseling encounters. Front Psychiatry 2023; 14:1110527. [PMID: 37032952 PMCID: PMC10076638 DOI: 10.3389/fpsyt.2023.1110527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/23/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction With the increasing utilization of text-based suicide crisis counseling, new means of identifying at risk clients must be explored. Natural language processing (NLP) holds promise for evaluating the content of crisis counseling; here we use a data-driven approach to evaluate NLP methods in identifying client suicide risk. Methods De-identified crisis counseling data from a regional text-based crisis encounter and mobile tipline application were used to evaluate two modeling approaches in classifying client suicide risk levels. A manual evaluation of model errors and system behavior was conducted. Results The neural model outperformed a term frequency-inverse document frequency (tf-idf) model in the false-negative rate. While 75% of the neural model's false negative encounters had some discussion of suicidality, 62.5% saw a resolution of the client's initial concerns. Similarly, the neural model detected signals of suicidality in 60.6% of false-positive encounters. Discussion The neural model demonstrated greater sensitivity in the detection of client suicide risk. A manual assessment of errors and model performance reflected these same findings, detecting higher levels of risk in many of the false-positive encounters and lower levels of risk in many of the false negatives. NLP-based models can detect the suicide risk of text-based crisis encounters from the encounter's content.
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Affiliation(s)
- Meghan Broadbent
- Educational Psychology, The University of Utah, Salt Lake City, UT, United States
| | - Mattia Medina Grespan
- Kahlert School of Computing, The University of Utah, Salt Lake City, UT, United States
| | - Katherine Axford
- Educational Psychology, The University of Utah, Salt Lake City, UT, United States
| | - Xinyao Zhang
- Educational Psychology, The University of Utah, Salt Lake City, UT, United States
| | - Vivek Srikumar
- Kahlert School of Computing, The University of Utah, Salt Lake City, UT, United States
| | - Brent Kious
- Department of Psychiatry, The University of Utah, Salt Lake City, UT, United States
| | - Zac Imel
- Educational Psychology, The University of Utah, Salt Lake City, UT, United States
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19
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Kendall PC, Maxwell CA, Jakubovic RJ, Ney JS, McKnight DS, Baker S. CBT for Youth Anxiety: How Does It Fit Within Community Mental Health? Curr Psychiatry Rep 2023; 25:13-18. [PMID: 36484914 DOI: 10.1007/s11920-022-01403-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW We review (1) the empirical literature for cognitive behavioral therapy (CBT) for youth anxiety delivered in community settings, (2) the use of online delivery methods in this process, and (3) identified barriers and facilitators to implementation of CBT for youth anxiety in community mental health clinics (CMHCs). We provide suggestions for future work. RECENT FINDINGS Meta-analytic reviews of effectiveness studies suggest that outcomes comparable to those of efficacy studies can be achieved in community settings, particularly when in-session exposures occur. Several online programs support delivery of these services, with an evidence base that is promising. The notable barrier to the implementation of services is the cost of implementation and sustainability. Organizational factors such as leadership, culture, and climate are consistently identified as barriers and facilitators depending on their valence and appear to be related to implementation outcomes (e.g., on provider attitudes). The current findings need to be integrated into future studies, with a focus on further identifying facilitators (e.g., champions and online programs) of implementation. There is also the need for efforts to address organizational and individual barriers and to compare ways to reduce costs.
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Affiliation(s)
- Philip C Kendall
- Department of Psychology and Neuroscience, Temple University, 1701 N. 13thStreet, Philadelphia, PA, 19122, USA.
| | - Colleen A Maxwell
- Department of Psychology and Neuroscience, Temple University, 1701 N. 13thStreet, Philadelphia, PA, 19122, USA
| | - Rafaella J Jakubovic
- Department of Psychology and Neuroscience, Temple University, 1701 N. 13thStreet, Philadelphia, PA, 19122, USA
| | - Julia S Ney
- Department of Psychology and Neuroscience, Temple University, 1701 N. 13thStreet, Philadelphia, PA, 19122, USA
| | - Dominique S McKnight
- Department of Psychology and Neuroscience, Temple University, 1701 N. 13thStreet, Philadelphia, PA, 19122, USA
| | - Samantha Baker
- Department of Clinical Psychology, Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA, 19131, USA
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Last BS, Johnson C, Dallard N, Fernandez-Marcote S, Zinny A, Jackson K, Cliggitt L, Rudd BN, Mills C, Beidas RS. Implementing trauma-focused cognitive behavioral therapy in Philadelphia: A 10-year evaluation. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231199467. [PMID: 37790185 PMCID: PMC10496473 DOI: 10.1177/26334895231199467] [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: 10/05/2023] Open
Abstract
Background: In 2012, Philadelphia's Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) developed an initiative to implement an evidence-based treatment for posttraumatic stress disorder (PTSD), trauma-focused cognitive behavioral therapy (TF-CBT), across the city's behavioral health system. This report evaluates the initiative's 10-year implementation and effectiveness outcomes. Method: The Exploration, Preparation, Implementation, and Sustainment framework guided our implementation evaluation. The implementation outcomes include adoption, reach, and sustainment; these were obtained during regular evaluation data collection from publicly funded behavioral health agencies participating in the TF-CBT initiative. We analyze effectiveness outcomes (i.e., changes in PTSD symptoms) from a subset of patients receiving TF-CBT, which were collected in 6-month intervals by our research team between 2013 and 2021. Results: From 2012 to 2021, DBHIDS trained 478 clinicians in TF-CBT across 20 behavioral health agencies. During this time, 23,401 youths were screened for potentially traumatic events and PTSD symptoms, and 7,550 youths received TF-CBT. Through the TF-CBT initiative, the city expanded the network of TF-CBT providers from 3 to 20 agencies. DBHIDS sustained this network by maintaining the participation of 16 behavioral health agencies over the course of a decade. The subset of 202 youths who were evaluated to assess TF-CBT effectiveness was drawn from 94 therapists and 20 agencies across Philadelphia. All participating youths completed a baseline assessment, and 151 (75%) completed at least one follow-up assessment. Linear mixed-effects models accounting for observations nested within participants and nested within clinicians found that treatment significantly reduced PTSD symptoms. Conclusion: Between 2012 and 2021, DBHIDS successfully implemented and sustained TF-CBT across the city's behavioral health system. Adoption, reach, and sustainment of TF-CBT were high. Despite the considerable adverse experiences faced by youths seeking treatment in Philadelphia's behavioral health system, TF-CBT was effective. Future directions to improve TF-CBT implementation in the next iteration of the initiative are described.
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Affiliation(s)
- Briana S. Last
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christina Johnson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Natalie Dallard
- Community Behavioral Health, Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
| | - Sara Fernandez-Marcote
- Community Behavioral Health, Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
| | - Arturo Zinny
- Community Behavioral Health, Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
- Center for Nonviolence and Social Justice, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Kamilah Jackson
- Community Behavioral Health, Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
- Talawa International Consultants, Philadelphia, PA, USA
| | - Lauren Cliggitt
- Hall-Mercer Community Mental Health Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brittany N. Rudd
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Chynna Mills
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rinad S. Beidas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Professional wellbeing and turnover intention among child therapists: a comparison between therapists trained and untrained in Trauma-Focused Cognitive Behavioral Therapy. BMC Health Serv Res 2022; 22:1328. [DOI: 10.1186/s12913-022-08670-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Poor professional wellbeing and job turnover is challenging for child mental health clinics and despite an increasing interest in implementing evidence-based practices (EBPs) in mental health services, little is known about if and how using EBPs may influence therapists’ professional wellbeing and turnover intention. To investigate this, we compare the average level of compassion satisfaction, burnout, secondary traumatic stress, and turnover intention between therapists trained in an EBP (Trauma-Focused Cognitive Behavioral Therapy – TF-CBT) and untrained therapists. We also explore the prevalence of and the associations between these personal and organizational outcomes.
Method
In this cross-sectional study, the data is collected from a national sample of 373 therapists 5 years after an implementation program began (i.e., in the sustainment phase). The variables were measured by the Professional Quality of Life and the Turnover Intention Scales. The Evidence-Based Practice Attitude Scale was also used to measure therapists’ attitudes toward EBPs.
Results
Over 70% of the respondents reported medium to high levels of burnout, secondary traumatic stress symptoms, and compassion satisfaction, whereas one-third of the respondents reported a high level of intention to leave their job in the current or near future. Higher ratings on burnout and secondary traumatic stress were significantly associated with lower compassion satisfaction and higher turnover intention. Finally, we found significantly lower degree of burnout and turnover intention along with higher compassion satisfaction among TF-CBT therapists (n = 96), compared to other therapists who were not trained in TF-CBT (n = 231). These differences could not be explained by between-group differences in age, job tenure, educational background, or therapists’ attitudes towards EBPs. However, mean differences in ratings on secondary traumatic stress symptoms were not statistically significant.
Conclusion
Although the prevalence findings are in general alarming, the present study provides the first empirical evidence for a potential positive effect of being trained in TF-CBT on therapists’ wellbeing and turnover intention. We discuss these findings in the light of self-efficacy theory and the job demands-resources model.
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Sofouli E, Wiltsey-Stirman S, Groleau D, Perreault M, Piat M. Identifying and Exploring Sustainability Determinants of Mental Health Recovery-Oriented Interventions: A Mixed Methods Study Protocol. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2022; 2:249-261. [PMID: 36035969 PMCID: PMC9395767 DOI: 10.1007/s43477-022-00052-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
Mental health recovery is the new paradigm in the mental health service delivery system worldwide. Recovery-oriented services go beyond traditional clinical care that is centered on symptom remission, aiming to help people: restore social connections with other individuals and the community; develop hope and optimism for the future; reconstruct an identity beyond that of a “mental patient”; discover meaning in life; and feel empowered to gain control over treatment (CHIME framework). Over the last ten years, several efforts at implementation of recovery-oriented interventions have been documented in the scientific literature. However, little attention has been given to their sustainability, even though it is reported that not all health interventions can fully sustain their activities beyond the initial implementation phase. The aim of this mixed methods case study is to better understand the factors that determine the sustainability of two recovery-oriented interventions (peer support and recovery training) after their roll-out in four organizations in Canada that provide community housing for adults with mental health challenges. Qualitative and quantitative data will be collected from managers, service providers, and implementation team members that oversaw the implementation process along with organizational documents. Data collection and analysis will be guided by the Consolidated Framework for Sustainability Constructs in Healthcare, the Framework for Reporting Adaptations and Modifications, and the Program Sustainability Assessment Tool. Findings will expand our current evidence base on the intersection of sustainability and mental health recovery interventions that remains under-explored.
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Last BS, Schriger SH, Becker-Haimes EM, Fernandez-Marcote S, Dallard N, Jones B, Beidas RS. Economic Precarity, Financial Strain, and Job-Related Stress Among Philadelphia's Public Mental Health Clinicians. Psychiatr Serv 2022; 73:774-786. [PMID: 34839673 DOI: 10.1176/appi.ps.202100276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Efforts to improve mental health treatment delivery come at a time of rising inequality and cuts or insufficient increases to mental health funding. Public mental health clinicians face increased demands, experience economic stress, and treat underresourced patients disproportionately burdened by trauma. The authors sought to understand clinicians' current economic and psychological conditions and the relationship of these conditions to the delivery of an evidence-based intervention (EBI) designed to treat posttraumatic stress disorder among youths. METHODS In July 2020, 49 public mental health clinicians from 16 Philadelphia clinics who were trained in an EBI, trauma-focused cognitive-behavioral therapy (TF-CBT), were surveyed by e-mail. Respondents reported on their economic precarity, financial strain, burnout, secondary traumatic stress (i.e., the stress response associated with caring for people exposed to trauma), and TF-CBT use. Associations between clinicians' job-related stressors and their use of TF-CBT were examined with mixed models. Content coding was used to organize clinicians' open-ended responses to questions regarding financial strain related to the COVID-19 pandemic. RESULTS Clinicians' economic precarity, financial strain, and job-related stress were high; 37% of clinicians were independent contractors, 44% of whom wanted a salaried position. Of 37 clinicians with education debt, 38% reported owing ≥$100,000. In the past year, 29% of clinicians reported lack of personal mental health care because of cost, and 22% met the cutoff for experiencing secondary traumatic stress symptoms. Education debt was negatively associated with use of TF-CBT (p<0.001). CONCLUSIONS The stress of providing care in underresourced clinical settings may interfere with efforts to integrate scientific evidence into mental health care.
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Affiliation(s)
- Briana S Last
- Department of Psychology, University of Pennsylvania, Philadelphia (Last, Schriger);Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Becker-Haimes, Beidas);Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia (Becker-Haimes); Community Behavioral Health, Philadelphia (Fernandez-Marcote, Dallard, Jones); Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
| | - Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia (Last, Schriger);Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Becker-Haimes, Beidas);Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia (Becker-Haimes); Community Behavioral Health, Philadelphia (Fernandez-Marcote, Dallard, Jones); Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
| | - Emily M Becker-Haimes
- Department of Psychology, University of Pennsylvania, Philadelphia (Last, Schriger);Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Becker-Haimes, Beidas);Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia (Becker-Haimes); Community Behavioral Health, Philadelphia (Fernandez-Marcote, Dallard, Jones); Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
| | - Sara Fernandez-Marcote
- Department of Psychology, University of Pennsylvania, Philadelphia (Last, Schriger);Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Becker-Haimes, Beidas);Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia (Becker-Haimes); Community Behavioral Health, Philadelphia (Fernandez-Marcote, Dallard, Jones); Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
| | - Natalie Dallard
- Department of Psychology, University of Pennsylvania, Philadelphia (Last, Schriger);Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Becker-Haimes, Beidas);Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia (Becker-Haimes); Community Behavioral Health, Philadelphia (Fernandez-Marcote, Dallard, Jones); Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
| | - Bryanna Jones
- Department of Psychology, University of Pennsylvania, Philadelphia (Last, Schriger);Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Becker-Haimes, Beidas);Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia (Becker-Haimes); Community Behavioral Health, Philadelphia (Fernandez-Marcote, Dallard, Jones); Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
| | - Rinad S Beidas
- Department of Psychology, University of Pennsylvania, Philadelphia (Last, Schriger);Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Becker-Haimes, Beidas);Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia (Becker-Haimes); Community Behavioral Health, Philadelphia (Fernandez-Marcote, Dallard, Jones); Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
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24
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Goh YS, Ow Yong QYJ, Soo SC, Wan PCJ, Ng VCK. Experiences and challenges faced by community mental health workers when providing care to people with mental health conditions: A qualitative descriptive study. Int J Ment Health Nurs 2022; 31:591-600. [PMID: 35075757 DOI: 10.1111/inm.12977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 12/14/2022]
Abstract
The global prevalence of mental health conditions and the associated wide treatment gaps have led to increased demand for quality mental healthcare services. In Singapore, despite a shift towards a joint provision of mental healthcare in hospitals and the community, experiences of mental healthcare teams in such hospital-community partnerships have remained unclear. Through a qualitative descriptive approach, this study explored community mental health workers' experiences and perceptions of working with partners from tertiary hospitals and other community organisations. Eighteen participants were individually interviewed with a semi-structured question guide through video conferencing. This study was guided by the 32-item checklist from the Consolidated Criteria for Reporting Qualitative Research. Data were subjected to Braun and Clark's six-step thematic analysis. Three themes emerged: (i) the need for supportive partners, due to institutional and legal challenges faced in the participants' liaison with hospital partners and other community organisations; (ii) the need for a supportive organisation, whose presence and importance were revealed by the interviews; and (iii) the necessity of advanced training, identified by the participants as a contributor to their professional growth. The findings highlighted the importance of inter-sectoral communication and positive effects of a robust organisational support system. Accordingly, hospitals and community mental healthcare organisations should consider strengthening networking and boosting case discussions through regular inter-sectoral meetings that would prioritise the clients' continuity of care. Furthermore, opportunities for advanced trainings should be created for community-based mental healthcare workers.
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Affiliation(s)
- Yong-Shian Goh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Qing Yun Jenna Ow Yong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shuenn-Chiang Soo
- National University Hospital, National University Health System, Singapore, Singapore
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Davis M, Hoskins K, Phan M, Hoffacker C, Reilly M, Fugo PB, Young JF, Beidas RS. Screening Adolescents for Sensitive Health Topics in Primary Care: A Scoping Review. J Adolesc Health 2022; 70:706-713. [PMID: 34955356 PMCID: PMC9038619 DOI: 10.1016/j.jadohealth.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022]
Abstract
We sought to aggregate common barriers and facilitators to screening adolescents for sensitive health topics (e.g., depression, chlamydia) in primary care, as well as those that are unique to a given health topic. We conducted a literature search of three databases (PsycInfo, MEDLINE, and CINAHL) and reference lists of included articles. Studies focused on barriers and facilitators to screening adolescents (ages 12-17 years) for sensitive health topics in primary care that are recommended by national guidelines. Articles were peer-reviewed, presented empirical data, and were published in English in 2006-2021. We coded barriers and facilitators using the Consolidated Framework for Implementation Research, a well-established framework within implementation science. In total, 39 studies met inclusion criteria and spanned several health topics: depression, suicide, substance use, HIV, and chlamydia. We found common barriers and facilitators to screening across health topics, with most relating to characteristics of the primary care clinics (e.g., time constraints). Other factors relevant to screening implementation ranged from confidentiality concerns to clinician knowledge. Barriers and facilitators specific to certain health topics, such as the availability of on-site laboratories for HIV screening, were also noted. Findings can guide refinements to screening implementation.
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Affiliation(s)
- Molly Davis
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Katelin Hoskins
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary Phan
- Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, Utah
| | - Carlin Hoffacker
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Megan Reilly
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Perrin B Fugo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jami F Young
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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LaRocco-Cockburn A, Jakupcak M, Bauer AM, Bowen DJ, Bechtel J, Koconis N, Fortney JC. Care managers' experiences in a collaborative care program for the treatment of bipolar disorder and PTSD in underserved communities. Gen Hosp Psychiatry 2022; 76:16-24. [PMID: 35313202 DOI: 10.1016/j.genhosppsych.2022.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 02/17/2022] [Accepted: 03/03/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To understand care managers' experiences treating primary care patients with bipolar disorder and PTSD in a telepsychiatry collaborative care (TCC) program, as part of a large pragmatic trial. METHODS We conducted individual qualitative interviews with 12 care managers to evaluate barriers and facilitators to implementation of a previously completed TCC intervention for patients with bipolar disorder and/or PTSD. We used directed and conventional content analysis and Consolidated Framework for Implementation Research (CFIR) constructs to organize care manager experiences. RESULTS Participants described clinical and medication management support from telepsychiatrists and satisfaction with the TCC model as facilitators of success for patients with bipolar disorder and PTSD in underserved communities. Participants also described onboarding of primary care providers and clinic leadership as keys to successful team-care and credited satisfaction with providing Behavioral Activation as essential to sustained delivery of the psychotherapy component of TCC. CONCLUSIONS Participants described high satisfaction with TCC for patients with bipolar disorder and PTSD. Challenges included lack of clinic leadership and PCP engagement. Early and ongoing promotion of integrated care and prioritizing telepsychiatry consultation with patients, behavioral health professionals and PCPs, may improve patient care, provide ongoing training and improve workforce satisfaction.
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Affiliation(s)
- Anna LaRocco-Cockburn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America; LaRocco Counseling, PLLC, 2366 Eastlake Ave E, Suite 234, Seattle, WA 98102, United States of America.
| | - Matthew Jakupcak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America; Lyra Health, 287 Lorton Ave, Burlingame, CA 94010, United States of America.
| | - Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America.
| | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, Box 357120, Seattle, WA, United States of America.
| | - Jared Bechtel
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America.
| | - Natalie Koconis
- University of Washington, Institute for Public Health Genetics, in association with the Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America.
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America; Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Values-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America.
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Brennan LA, Brady JE, Drummond KL, Wiltsey-Stirman S, Gutner CA, Iverson KM. Mental health clinician perspectives regarding factors impacting implementation of evidence-based psychotherapies in Veterans Health Administration community-based outpatient clinics. Gen Hosp Psychiatry 2022; 75:54-60. [PMID: 35182907 DOI: 10.1016/j.genhosppsych.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Uptake of Evidence-Based Psychotherapies (EBPs) by mental health (MH) clinicians, especially in community settings, remains highly variable. This formative pilot study aimed to understand the attitudes and practices of Veterans Health Administration community-based MH clinicians regarding EBPs and to identify multi-level factors that enable and hinder EBP implementation in this unique context. METHODS Semi-structured interviews were conducted with MH clinicians (N = 40) working in community-based outpatient clinics (CBOCs) in metro/urban (n = 20) and non-metro/rural (n = 20) locations. Interviews were guided by the Consolidated Framework for Implementation Research and were analyzed using rapid content analysis. Results were organized by system-, clinician-, patient-, and innovation-levels. RESULTS EBPs were consistently perceived as important to delivering quality MH care, with most clinicians having received training in at least one VHA EBP. However, limited EBP training and consultation opportunities, inadequate autonomy to schedule EBP sessions, high and complex caseloads, and feelings of isolation at CBOCs decreased EPB use. Social workers perceived disparities in EBP training access relative to psychologists. Some barriers were more salient in non-metro/rural settings (e.g., patient-level privacy concerns). CONCLUSIONS Increased EBP training opportunities- particularly for social workers-, greater flexibility over schedules and caseloads, and more mechanisms for consultation and professional development may increase EBP uptake in community-based clinics.
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Affiliation(s)
- Laura A Brennan
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, USA.
| | - Julianne E Brady
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, USA; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, USA
| | - Karen L Drummond
- Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA; Department of Psychiatry, University of Arkansas for Medical Sciences, North Little Rock, AR, United States of America
| | - Shannon Wiltsey-Stirman
- Dissemination and Training Division, National Center for PTSD, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, USA
| | - Cassidy A Gutner
- ViiV Healthcare, Innovation & Implementation Science, Research Triangle, NC, USA; Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Boston, MA, USA
| | - Katherine M Iverson
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, USA; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Boston, MA, USA.
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Becker-Haimes EM, Wislocki K, DiDonato S, Jensen-Doss A. Predictors of Clinician-Reported Self-Efficacy in Treating Trauma-Exposed Youth. J Trauma Stress 2022; 35:109-119. [PMID: 34048094 PMCID: PMC10676627 DOI: 10.1002/jts.22688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/09/2022]
Abstract
Clinicians' self-efficacy with regard to delivering evidence-based interventions (EBIs) to youth is an important target for both improving EBI use in the community and mitigating the risk of clinician burnout and turnover. Examining predictors of clinician self-efficacy to treat trauma-exposed youth is, therefore, an important step for informing the design of implementation strategies to enhance the mental health workforce's capacity to deliver EBIs in this population. We examined predictors of clinician self-efficacy in working with trauma-exposed youth in a sample of practicing mental health clinicians (N = 258, M age = 34.4 years, 85.0% female). Clinicians were recruited and surveyed as part of a larger study examining how clients' exposure to potentially traumatic events influences clinician decision-making. Results of regression models indicated that training in any trauma treatment model, being trained via a variety of formats (e.g., in-person training, online, supervision), and training in a variety of treatment models were all associated with higher perceived self-efficacy regarding effectively treating trauma-exposed youth. Of the treatment models and training formats examined, receiving in-person training, R2 = .10, and training in trauma-focused cognitive behavioral therapy, R2 = .10, were the strongest predictors of higher self-efficacy ratings. Clinician discipline, R2 = .04, and clinical practice factors, R2 = .20, were also related to self-efficacy. Collectively, the R2 indicated a large effect, with the predictors explaining 25.4% of the variance in self-efficacy ratings. Implications for designing implementation strategies targeting clinician self-efficacy and future research are discussed.
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Affiliation(s)
- Emily M. Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
- Hall Mercer Community Mental Health, University of Pennsylvania Health System
| | - Katherine Wislocki
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
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Lewis CC, Scott K, Rodriguez-Quintana N, Hoffacker C, Boys C, Hindman R. Implementation of the Wolverine Mental Health Program, Part 3: Sustainment Phase. COGNITIVE AND BEHAVIORAL PRACTICE 2022; 29:244-255. [PMID: 35310457 PMCID: PMC8932444 DOI: 10.1016/j.cbpra.2021.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Sustaining the implementation of an evidence-based practice (EBP) is the ultimate goal of often years of significant personnel and financial investment. Some conceptualize sustainment as a distinct phase following an active implementation period where the contextual factors, processes, and supports are bolstered to ensure continued EBP delivery. This study provides an overview of the sustainment strategies deployed to embed cognitive-behavioral therapy (CBT) in a Midwestern residential treatment facility serving youth with complex mental health needs. Seven key strategies and their outcomes are described: use of CBT teams, new hire orientation plans, monthly campaigns, change in job descriptions and performance evaluations, development of a behavioral reinforcement system for youth, and a pathway to CBT certification. This study provides a window into how one might sustain an EBP by addressing barriers unique to this phase of work.
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Affiliation(s)
- Cara C Lewis
- Kaiser Permanente Washington Health Research Institute
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Dopp AR, Gilbert M, Silovsky J, Ringel JS, Schmidt S, Funderburk B, Jorgensen A, Powell BJ, Luke DA, Mandell D, Edwards D, Blythe M, Hagele D. Coordination of sustainable financing for evidence-based youth mental health treatments: protocol for development and evaluation of the fiscal mapping process. Implement Sci Commun 2022; 3:1. [PMID: 34983689 PMCID: PMC8724666 DOI: 10.1186/s43058-021-00234-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sustained delivery of evidence-based treatments (EBTs) is essential to addressing the public health and economic impacts of youth mental health problems, but is complicated by the limited and fragmented funding available to youth mental health service agencies (hereafter, "service agencies"). Strategic planning tools are needed that can guide these service agencies in their coordination of sustainable funding for EBTs. This protocol describes a mixed-methods research project designed to (1) develop and (2) evaluate our novel fiscal mapping process that guides strategic planning efforts to finance the sustainment of EBTs in youth mental health services. METHOD Participants will be 48 expert stakeholder participants, including representatives from ten service agencies and their partners from funding agencies (various public and private sources) and intermediary organizations (which provide guidance and support on the delivery of specific EBTs). Aim 1 is to develop the fiscal mapping process: a multi-step, structured tool that guides service agencies in selecting the optimal combination of strategies for financing their EBT sustainment efforts. We will adapt the fiscal mapping process from an established intervention mapping process and will incorporate an existing compilation of 23 financing strategies. We will then engage participants in a modified Delphi exercise to achieve consensus on the fiscal mapping process steps and gather information that can inform the selection of strategies. Aim 2 is to evaluate preliminary impacts of the fiscal mapping process on service agencies' EBT sustainment capacities (i.e., structures and processes that support sustainment) and outcomes (e.g., intentions to sustain). The ten agencies will pilot test the fiscal mapping process. We will evaluate how the fiscal mapping process impacts EBT sustainment capacities and outcomes using a comparative case study approach, incorporating data from focus groups and document review. After pilot testing, the stakeholder participants will conceptualize the process and outcomes of fiscal mapping in a participatory modeling exercise to help inform future use and evaluation of the tool. DISCUSSION This project will generate the fiscal mapping process, which will facilitate the coordination of an array of financing strategies to sustain EBTs in community youth mental health services. This tool will promote the sustainment of youth-focused EBTs.
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Affiliation(s)
- Alex R Dopp
- Department of Behavioral and Policy Sciences, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Marylou Gilbert
- Department of Behavioral and Policy Sciences, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Jane Silovsky
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Jeanne S Ringel
- Department of Economics, Sociology, and Statistics, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Susan Schmidt
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Beverly Funderburk
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Ashley Jorgensen
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School and School of Medicine, Washington University, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Douglas A Luke
- Brown School, Washington University, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - David Mandell
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Fl., Philadelphia, PA, 19104, USA
| | - Daniel Edwards
- Evidence-Based Associates, 1311 Delaware Ave, Suite 637, Washington, DC, 20024, USA
| | - Mellicent Blythe
- NC Child Treatment Program c/o Center for Child and Family Health, 1121 W, Chapel Hill St. Ste. 100, Durham, NC, 27701, USA
| | - Dana Hagele
- NC Child Treatment Program c/o Center for Child and Family Health, 1121 W, Chapel Hill St. Ste. 100, Durham, NC, 27701, USA
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Ryan R, Berry K, Hartley S. Review: Therapist factors and their impact on therapeutic alliance and outcomes in child and adolescent mental health - a systematic review. Child Adolesc Ment Health 2021; 28:195-211. [PMID: 34763371 DOI: 10.1111/camh.12518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Young people's mental health is a significant concern globally. The evidence suggests that there is a strong relationship between therapeutic alliance and children's reported outcomes such as symptoms and dropout of services. There are indications that therapist characteristics - including static qualities and dynamic behaviours - can be associated with both alliance and outcomes. METHOD The aim of this review was to systematically collate, summarise and critique studies reporting on therapist characteristics that might influence the therapeutic alliance or outcomes for young people accessing child and adolescent mental health services. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed, and four databases (PsycINFO, PsycARTICLES, MEDLINE and CINAHL) were searched for 'therapist' and 'characteristic' combined with 'alliance' or 'outcome' and related terms associated with these topics. RESULTS A review of 15 papers showed that therapists' in-session behaviours and interpersonal style have a significant impact on alliance or outcome. One study also indicated important associations with attachment style. Findings related to ethnicity, gender and level of experience were complex; highlighting differences between subgroups, ages, outcome measurement and diagnostic categories. Methodological issues such as secondary analysis on administrative data confounded the interpretation of results. CONCLUSIONS There are indications that specific therapist factors can impact on alliance and outcomes in child and adolescent mental health services. Future research needs to adopt a prospective design and measure therapist characteristics and their relationship to alliance or outcome over time in a broad range of settings.
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Affiliation(s)
- Rachael Ryan
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Samantha Hartley
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK.,Pennine Care NHS Foundation Trust, Greater Manchester, UK
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32
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Barnett ML, Klein CC, Gonzalez JC, Sanchez BE, Rosas YG, Corcoran F. How do Lay Health Worker Engage Caregivers? A Qualitative Study to Enhance Equity in Evidence-Based Parenting Programs. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2021; 8:221-235. [PMID: 37323826 PMCID: PMC10266647 DOI: 10.1080/23794925.2021.1993111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Engaging caregivers in their children's mental health treatment is critical for delivering high quality, evidence-based care, particularly for young children with externalizing behaviors. Lay health workers (LHWs), including peer providers and promotoras de salud, have been identified as important workforces in addressing structural and stigma-related barriers to engagement in mental health services. Importantly, research has suggested that LHWs may be integral in efforts to address engagement disparities in evidence-based behavioral parent training programs (BPTs) for Latinx caregivers. The purpose of the study was to understand how different LHW workforces engage caregivers within their usual services, in order to inform strategies that improve access to and engagement in BPTs. Qualitative interviews were conducted with two different LHW workforces: volunteer LHWs (i.e., promotoras de salud) (n = 14), who were part of a community-embedded network, and paid LHWs (i.e., parent support partners, home visitors) (n = 9) embedded within children's mental health agencies. Participants were predominately Latinx (79%) and female (96%). Qualitative analyses revealed three primary themes related to engagement strategies used by LHWs to address barriers to care: 1.) Building Trust, 2.) Empowerment, 3.) Increasing Access. Although the majority of themes and sub-themes were consistent across the two LHW workforces, agency-embedded LHWs often discussed having the means to provide resources through their organizations, whereas community-embedded LHWs discussed acting as a bridge to services by providing information and conducting outreach. Findings have implications for partnering with different workforces of LHWs to increase equity in access to BPTs.
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Affiliation(s)
- Miya L Barnett
- Department of Counseling, Clinical and School Psychology, University of California, Santa Barbara, CA
| | - Corinna C Klein
- Department of Counseling, Clinical and School Psychology, University of California, Santa Barbara, CA
| | - Juan Carlos Gonzalez
- Department of Counseling, Clinical and School Psychology, University of California, Santa Barbara, CA
| | - Berta Erika Sanchez
- Department of Counseling, Clinical and School Psychology, University of California, Santa Barbara, CA
| | - Yessica Green Rosas
- Department of Counseling, Clinical and School Psychology, University of California, Santa Barbara, CA
| | - Frederique Corcoran
- Department of Counseling, Clinical and School Psychology, University of California, Santa Barbara, CA
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Westfall MBE, Kohler CG, Hurford I, Abegunde C, Agosti D, Brinen A, Cadman ML, Conroy C, Ered A, Fooks A, Franco O, Huque ZM, Namowicz D, O'Connor S, Oross M, Payne E, Sarpal DK, Schmidt LR, Swigart A, Wenzel RM, Calkins ME. Pennsylvania coordinated specialty care programs for first-episode psychosis: 6- and 12-month outcomes. Early Interv Psychiatry 2021; 15:1395-1408. [PMID: 33283472 DOI: 10.1111/eip.13084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/16/2020] [Accepted: 11/14/2020] [Indexed: 01/21/2023]
Abstract
AIM Pennsylvania (PA) first-episode psychosis (FEP) program evaluation is a statewide initiative, supported by the PA Office of Mental Health and Substance Abuse Services (PA-OMHSAS) and administered by PA Early Intervention Center/Heads Up, which evaluates fidelity and outcomes of PA Coordinated Specialty Care (CSC) programs. Programs participate in standard computerized measures of CSC outcomes using centralized informatics. The aims of the current report are to describe implementation of this core battery for program evaluation in PA and to present 6- and 12-month outcomes. METHODS Participants (n = 697) from nine PA CSC programs completed the core battery at admission. The battery was re-administered at 6- and 12-month follow-up, and data were analysed for individuals (n = 230) who had completed 12-months of treatment. Domains assessed via clinician report and/or self-report included symptoms, role and social functioning, self-perceived recovery and service utilization. RESULTS PA FEP CSC participants showed improvement over time in several domains, including decreased symptoms, higher role and social functioning, decreased hospitalizations, and improved self-perception of recovery, quality of life, and services satisfaction. Trends towards improvements were observed for participant happiness, hopelessness, and school-enrolment. Nearly all improvements were observed at 6-month follow-up, with earlier gains maintained at 12-months. CONCLUSIONS PA FEP CSC programs demonstrate the ability to assess and improve critical outcomes of coordinated specialty care in PA. Improved outcomes by 12 months in treatment provides evidence of an effective treatment model and supports the continuation of these programs in pursuit of our goal of reducing schizophrenia disease burden on individuals and society.
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Affiliation(s)
- Megan B E Westfall
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian G Kohler
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Irene Hurford
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Courtney Abegunde
- STEP Clinic, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Dominick Agosti
- Connect 2 Empower, CMSU Behavioral Health Services, Danville, Pennsylvania, USA
| | - Aaron Brinen
- Department of Psychiatry, Drexel College of Medicine, Philadelphia, Pennsylvania, USA
| | - Mary Lyn Cadman
- Connect 2 Empower, CMSU Behavioral Health Services, Danville, Pennsylvania, USA
| | - Catherine Conroy
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arielle Ered
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Amanda Fooks
- CAPSTONE, Pennsylvania Psychiatric Institute, Harrisburg, Pennsylvania, USA
| | - Olivia Franco
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zeeshan M Huque
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Denise Namowicz
- Helping to Overcome Psychosis Early (HOPE), Children's Service Center, Wilks-Barre, Pennsylvania, USA
| | - Seamus O'Connor
- On My Way, Child and Family Focus, Inc., Broomall, Pennsylvania, USA
| | - Molly Oross
- ENGAGE, Wesley Family Services, Pittsburgh, Pennsylvania, USA
| | - Elisa Payne
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Deepak K Sarpal
- STEP Clinic, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Lyndsay R Schmidt
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alison Swigart
- CAPSTONE, Pennsylvania Psychiatric Institute, Harrisburg, Pennsylvania, USA
| | | | - Monica E Calkins
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Maxwell CA, Ehrhart MG, Williams NJ, Moore TM, Kendall PC, Beidas RS. The Organizational Financial Context of Publicly-Funded Mental Health Clinics: Development and Preliminary Psychometric Evaluation of the Agency Financial Status Scales. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:780-792. [PMID: 33740163 DOI: 10.1007/s10488-021-01128-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 01/08/2023]
Abstract
Funding is a major barrier to implementation of evidence-based practices (EBPs) in publicly-funded community mental health clinics (CMHCs). Understanding how best to deploy implementation strategies that address this barrier requires greater clarity on the financial context within agencies. We developed the Agency Financial Status Scales (AFSS) to assess employee perceptions of the level of three hypothesized and theoretical funding related constructs in organizations: (a) perceptions of financial health, (b) financial attitudes toward EBPs, and (c) strategic financial climate. This investigation serves as a preliminary evaluation of this measure. Participants were 239 therapists and 40 supervisors from 25 publicly-funded CMHCs providing outpatient mental health services for young people. Confirmatory factor analysis was used to investigate the latent trait structure of the items. Internal consistency, interrater agreement, concordance between therapists and supervisors, and convergent validity were also examined. A two-factor model measuring perceptions of financial health and strategic financial climate best fit the data. For both of these scales, alpha reliability was acceptable and agreement statistics provided moderate support for aggregation at the organizational level. Analyses supported the convergent validity of the scales. The development and preliminary evaluation of the AFSS is an important first step in understanding the financial context of publicly-funded CMHCs. Though findings from this investigation are promising, additional development and testing are needed to develop a more thorough understanding of the constructs and to improve the validity and reliability of this measure.
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Affiliation(s)
| | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, Orlando, USA
| | | | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, 3015, Philadelphia, PA, 19104, USA
| | | | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, 3015, Philadelphia, PA, 19104, USA.
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
- Penn Implementation Science Center At the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, USA.
- Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
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Rollins AL, Eliacin J, Russ-Jara AL, Monroe-Devita M, Wasmuth S, Flanagan ME, Morse GA, Leiter M, Salyers MP. Organizational conditions that influence work engagement and burnout: A qualitative study of mental health workers. Psychiatr Rehabil J 2021; 44:229-237. [PMID: 33793289 PMCID: PMC8440452 DOI: 10.1037/prj0000472] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: Clinician burnout in healthcare is extensive and of growing concern. In mental health and rehabilitation settings, research on interventions to improve burnout and work engagement is limited and rarely addresses organizational drivers of burnout. This study sought to elaborate on the organizational influence of burnout and work engagement in mental health. Methods: We randomly selected 40 mental health clinicians and managers who were participating in a burnout intervention and conducted semi-structured interviews to understand their views of organizational conditions impacting burnout and work engagement. Data were analyzed using a thematic analytical approach. Results: Analyses yielded three major themes where organizational contexts might reduce burnout and increase work engagement: (a) a work culture that prioritizes person-centered care over productivity and other performance metrics, (b) robust management skills and practices to overcome bureaucracy, and (c) opportunities for employee professional development and self-care. Participants also referenced three levels of the organizational context that they believed influenced burnout and work engagement: front-line supervisors and program managers, organizational executive leadership, and the larger health system. Conclusions and Implications for Practice: Findings point to several possible targets of intervention at various organizational levels that could guide the field toward more effective ways to reduce burnout and improve work engagement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Angela L Rollins
- VA HSR&D Center for Health Information and Communication, Veterans Health Indiana
| | - Johanne Eliacin
- VA HSR&D Center for Health Information and Communication, Veterans Health Indiana
| | - Alissa L Russ-Jara
- VA HSR&D Center for Health Information and Communication, Veterans Health Indiana
| | - Maria Monroe-Devita
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - Sally Wasmuth
- VA HSR&D Center for Health Information and Communication, Veterans Health Indiana
| | - Mindy E Flanagan
- VA HSR&D Center for Health Information and Communication, Veterans Health Indiana
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36
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Hwang E, Yi Y. Workplace spirituality and organizational justice in turnover intention of mental health professionals at small-sized centres. J Nurs Manag 2021; 30:328-335. [PMID: 34448518 DOI: 10.1111/jonm.13459] [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: 06/24/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Abstract
AIM To investigate the influence of workplace spirituality and organizational justice on the turnover intentions of mental health professionals working in small-sized communities. BACKGROUND Many community mental health facilities in Korea are consist of the small size of members, and the turnover rate of mental health professionals is high. However, the influence of individual and organizational factors for lowering the turnover is not clearly identified. METHOD This was a descriptive study. Data of 168 participants were collected through a self-reported online questionnaire using a convenience sample, June 2020. RESULT Multiple regression analysis uses interactional justice (β = -.437, p = .002), distributional justice (β = -.190, p = .011) and age (β = -.152, p = .033) that were the most important predictors of turnover intention. CONCLUSION Orgnisational factors such as distributional and interactional justice affect to reduce turnover intention more than an individual factor like the workplace spirituality of professionals. IMPLICATIONS FOR NURSING MANAGEMENT Small-sized mental health institutions in the community should establish a clear working guideline that can make the distribution, procedure and interactional justice. Because only a small percentage of nurses work at community mental health facilities, it is necessary to reduce turnover by creating a work environment where young nurse practitioners can work long-term and grow into leaders.
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Affiliation(s)
- Eunmi Hwang
- School of Nursing, Hanyang University, Seoul, South Korea
| | - Yeojin Yi
- School of Nursing, Hanyang University, Seoul, South Korea
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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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Perception of Recovery Orientation as a Predictor of Clinician Turnover in Community Mental Health Clinics. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:79-87. [PMID: 33956268 DOI: 10.1007/s10488-021-01142-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Turnover in community mental health clinics threaten the delivery of quality behavioral health services; recovery orientation has been shown to be associated with lower levels of burnout but its relationship with actual turnover has not yet been examined. This study aimed to examine the relationship between provider perceptions of recovery orientation and 12-month turnover status among community mental health providers. Secondary data analyses were conducted with data collected from 224 community mental health providers from ten organizations across 14 clinic sites participating in a larger effectiveness-implementation trial. Chi square analyses were used to examine between-site variation in 1-year turnover rates among the ten organizations. Logistic regression was used to examine effects of perceptions of recovery orientation along with known predictors of turnover among community mental health providers. Results revealed no between-site variation in organizational turnover rates. The logistic regression model was statistically significant, χ2(17) = 47.64, p < .0001 and explaining 30% (Nagelkerke R2) of within-site variance and correctly classifying 79% of cases. Perceptions of recovery orientation emerged as the sole significant predictor of 12-month turnover status, with higher levels of recovery orientation significantly associated with lower odds of turnover at 12 months [B = .90, p = .008, OR 2.47 (95% CI 1.23, 4.82)]. Perceptions of recovery orientation was protective against 12-month turnover status suggesting that a more person-centered and empowering approach to care may improve the provider experience. More research is needed to further understand how recovery orientation can contribute to workforce stability.
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Bradley WJ, Becker KD. Clinical Supervision of Mental Health Services: A Systematic Review of Supervision Characteristics and Practices Associated with Formative and Restorative Outcomes. CLINICAL SUPERVISOR 2021; 40:88-111. [PMID: 34045790 DOI: 10.1080/07325223.2021.1904312] [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: 10/21/2022]
Abstract
In this review, the authors examined supervision characteristics and practices associated with formative (e.g., skill development) and restorative (e.g., well-being) provider outcomes. We used qualitative review to summarize supervision characteristics associated with desired outcomes. Then, we applied a distillation approach (Chorpita et al., 2005) to identify practices associated with formative and restorative outcomes. The most common practices for promoting formative outcomes were corrective feedback, discussing intervention, and role play. Findings indicate several supervision strategies have demonstrated empirical support for improving formative outcomes. However, more rigorous research is needed in community settings, particularly for understanding which strategies improve restorative outcomes.
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Schriger SH, Becker-Haimes EM, Skriner L, Beidas RS. Clinical Supervision in Community Mental Health: Characterizing Supervision as Usual and Exploring Predictors of Supervision Content and Process. Community Ment Health J 2021; 57:552-566. [PMID: 32671507 PMCID: PMC7855099 DOI: 10.1007/s10597-020-00681-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 07/04/2020] [Indexed: 11/27/2022]
Abstract
Clinical supervision can be leveraged to support implementation of evidence-based practices in community mental health settings, though it has been understudied. This study focuses on 32 supervisors at 23 mental health organizations in Philadelphia. We describe characteristics of supervisors and organizations and explore predictors of supervision content and process. Results highlight a low focus on evidence-based content and low use of active supervision processes. They underscore the need for further attention to the community mental health context when designing supervision-targeted implementation strategies. Future work should assess whether supervision models specific to community mental health are needed.
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Affiliation(s)
- Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily M Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Room 3015, Philadelphia, PA, 19104, USA.,Hall-Mercer Community Mental Health Center, Philadelphia, PA, USA
| | - Laura Skriner
- Evidence-Based Practitioners of New Jersey, Summit, NJ, USA
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Room 3015, Philadelphia, PA, 19104, USA. .,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA. .,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Gopalan G, Bunger AC, Powell BJ. Skills for Developing and Maintaining Community-Partnerships for Dissemination and Implementation Research in Children's Behavioral Health: Implications for Research Infrastructure and Training of Early Career Investigators. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:227-243. [PMID: 30863918 DOI: 10.1007/s10488-019-00930-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
By engaging with community partners, dissemination and implementation scholars can enhance research relevance and translation. We illustrate the skills needed for developing and maintaining community partnerships by presenting two case studies of partnerships between early-career investigators and child welfare systems to implement mental health interventions. The cases represent two models of partnership (investigator-led and agency-led), highlighting the value and difficulty of conducting community-engaged implementation research. The experiences described feature strategies for building and managing relationships, navigating rules and regulations, adaptation, and securing resources. We offer suggestions for improving training and research infrastructures to support community-engaged implementation scholars.
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Affiliation(s)
- Geetha Gopalan
- Silberman School of Social Work, Hunter College, City University of New York, 2180 3rd Avenue, New York, NY, 10035, USA.
| | - Alicia C Bunger
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Byron J Powell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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When Do Therapists Stop Using Evidence-Based Practices? Findings from a Mixed Method Study on System-Driven Implementation of Multiple EBPs for Children. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:323-337. [PMID: 31720914 DOI: 10.1007/s10488-019-00987-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Therapist discontinuation of delivering an evidence-based practice (EBP) is a critical outcome in the community implementation of EBPs. This mixed methods study examined factors associated with therapist discontinuation within a large reimbursement-driven implementation of multiple EBPs in public children's mental health services. The study integrated quantitative survey data from 748 therapists across 65 agencies, and qualitative interviews from a subset of 79 therapists across 14 agencies. Therapists adopted, on average, 2.41 EBPs (SD = 1.05, range = 1-5), and nearly half (n = 355, 47.5%) reported discontinuing at least one EBP. Multi-level models were used to predict the binary outcome of discontinuation, and qualitative analyses were used to expand upon quantitative findings. Quantitative models revealed that therapist factors, including fewer direct service hours per week, a greater number of EBPs adopted, higher emotional exhaustion, and more negative attitudes toward EBPs in general were associated with discontinuation. In addition, EBP-specific factors including more negative perceptions of the particular EBP and lower self-efficacy for delivering the specific EBP predicted discontinuation. Themes from interview responses highlighted the importance of fit of the EBP with the agency's client base, as well as therapist perceptions of adequate EBP training supports, and the alignment of an EBP with therapists' professional goals. Together, the findings suggest the need for strategic sustainment planning interventions that target EBP fit (i.e., fit between adopted EBPs and agency target population, fit between EBP and therapist preferences and career goals) and support therapist self-efficacy in delivering EBPs.
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43
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Barnett ML, Brookman-Frazee L, Yu SH, Lind T, Lui JHL, Timmer S, Boys D, Urquiza A, Innes-Gomberg D, Quick-Abdullah D, Lau AS. Train-to-Sustain: Predictors of Sustainment in a Large-Scale Implementation of Parent-Child Interaction Therapy. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2021; 6:262-276. [PMID: 34239983 PMCID: PMC8259890 DOI: 10.1080/23794925.2020.1855613] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sustainment of evidence-based practices is necessary to ensure their public health impact. The current study examined predictors of sustainment of Parent-Child Interaction Therapy (PCIT) within a large-scale system-driven implementation effort in Los Angeles County. Data were drawn from PCIT training data and county administrative claims between January 2013 and March 2018. Participants included 241 therapists from 61 programs. Two sustainment outcomes were examined at the therapist- and program-levels: 1) PCIT claim volume and 2) PCIT claim discontinuation (discontinuation of claims during study period; survival time of claiming in months). Predictors included therapist- and program-level caseload, training, and workforce characteristics. On average, therapists and programs continued claiming to PCIT for 17.7 and 32.3 months, respectively. Across the sustainment outcomes, there were both shared and unshared significant predictors. For therapists, case-mix fit (higher proportions of young child clients with externalizing disorders) and participation in additional PCIT training activities significantly predicted claims volume. Furthermore, additional training activity participation was associated with lower likelihood of therapist PCIT claim discontinuation in the follow-up period. Programs with therapists eligible to be internal trainers were significantly less likely to discontinue PCIT claiming. Findings suggest that PCIT sustainment may be facilitated by implementation strategies including targeted outreach to ensure eligible families in therapist caseloads, facilitating therapist engagement in advanced trainings, and building internal infrastructure through train-the-trainer programs.
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Affiliation(s)
- Miya L Barnett
- University of California, Santa Barbara, Department of Counseling, Clinical, & School Psychology
| | - Lauren Brookman-Frazee
- University of California, San Diego, Department of Psychiatry
- Child and Adolescent Services Research Center
| | - Stephanie H Yu
- University of California, Los Angeles, Department of Psychology
| | - Teresa Lind
- University of California, San Diego, Department of Psychiatry
- Child and Adolescent Services Research Center
| | - Joyce H L Lui
- University of California, Los Angeles, Department of Psychology
| | | | | | | | | | | | - Anna S Lau
- University of California, Los Angeles, Department of Psychology
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Lau AS, Lind T, Motamedi M, Lui JHL, Kuckertz M, Innes-Gomberg D, Pesanti K, Brookman-Frazee L. Prospective predictors of sustainment of multiple EBPs in a system-driven implementation context: Examining sustained delivery based on administrative claims. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211057884. [PMID: 37090013 PMCID: PMC9978650 DOI: 10.1177/26334895211057884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background System-driven scale-up of multiple evidence-based practices (EBPs) is an increasingly common method used in public mental health to improve care. However, there are little data on the long-term sustained delivery of EBPs within these efforts, and previous studies have relied on retrospective self-report within cross-sectional studies. This study identified prospective predictors of sustained EBP delivery at the EBP-, therapist-, and organizational-levels using survey and administrative claims data within a large-scale system-driven implementation effort. Methods 777 therapists and 162 program leaders delivering at least one of six EBPs of interest completed surveys assessing perceptions of EBPs and organizational context. These surveys were linked to administrative data to examine prospective predictors of therapists' EBP delivery over 33 months. Results Five of the six EBPs implemented showed sustained delivery in the system, with volume varying by EBP. Although total EBP claim volume per therapist decreased over time, the volume ratio (ratio of EBP-specific claims to total EBP and non-EBP claims) stayed relatively stable. Multilevel models revealed that EBPs that required consultation, had unstructured content, higher therapist self-efficacy with the EBP, and more positive program leader perceptions of the EBP were associated with greater sustained volume and volume ratio of the EBP. Therapists who were trained in fewer EBPs, who were unlicensed, and who worked in agencies rated by program leaders as lower on organizational staff autonomy and stress showed greater sustained EBP volume and volume ratio. Finally, more direct service hours per week provided by therapist predicted greater sustained EBP volume, but lower volume ratio. Conclusions The results point to the importance of EBP, therapist, and organizational factors that may be targeted in implementation strategies to promote the sustainment of EBPs.
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Affiliation(s)
- Anna S. Lau
- Department of Psychology, University of California, 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
| | - Mojdeh Motamedi
- Child and Adolescent Services Research
Center (CASRC), San Diego, CA, USA
- Department of Psychiatry, University of California, La Jolla, CA, USA
| | - Joyce H. L. Lui
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Mary Kuckertz
- Child and Adolescent Services Research
Center (CASRC), San Diego, CA, USA
- Department of Psychiatry, University of California, La Jolla, CA, USA
| | | | - Keri Pesanti
- Los Angeles County Department of Mental
Health, Los Angeles, CA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research
Center (CASRC), San Diego, CA, USA
- Department of Psychiatry, University of California, La Jolla, CA, USA
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45
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Aarons GA, Conover KL, Ehrhart MG, Torres EM, Reeder K. Leader–member exchange and organizational climate effects on clinician turnover intentions. J Health Organ Manag 2020; 35:68-87. [DOI: 10.1108/jhom-10-2019-0311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeClinician turnover in mental health settings impacts service quality, including availability and delivery of evidence-based practices. Leadership is associated with organizational climate, team functioning and clinician turnover intentions (TI). This study examines leader–member exchange (LMX), reflecting the relationship between a supervisor and each supervisee, using mean team LMX, dispersion of individual clinician ratings compared to team members (i.e. relative LMX) and team level variability (i.e. LMX differentiation), in relation to organizational climate and clinician TI.Design/methodology/approachSurvey data were collected from 363 clinicians, nested in children's mental health agency workgroups, providing county-contracted outpatient services to youth and families. A moderated mediation path analysis examined cross-level associations of leader–member exchange with organizational climate and turnover intentions.FindingsLower relative LMX and greater LMX differentiation were associated with higher clinician TI. Higher team-level demoralizing climate also predicted higher TI. These findings indicate that poorer LMX and more variability in LMX at the team level are related to clinician TI.Originality/valueThis study describes both team- and clinician-level factors on clinician TI. Few studies have examined LMX in mental health, and fewer still have examined relative LMX and LMX differentiation associations with organizational climate and TI. These findings highlight the importance of leader–follower relationships and organizational climate and their associations with clinician TIs. Mental health service systems and organizations can address these issues through fostering more positive supervisor–supervisee relationships.
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46
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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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47
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Adams DR, Williams NJ, Becker-Haimes EM, Skriner L, Shaffer L, DeWitt K, Neimark G, Jones DT, Beidas RS. Therapist Financial Strain and Turnover: Interactions with System-Level Implementation of Evidence-Based Practices. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:713-723. [PMID: 31203492 DOI: 10.1007/s10488-019-00949-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Therapist turnover is a major problem in community mental health. Financial strain, which is composed of cognitive, emotional, and behavioral responses to the experience of economic hardship, is an understudied antecedent of therapist turnover given the tumultuous financial environment in community mental health. We prospectively examined the relationship between therapist financial strain and turnover in 247 therapists in 28 community mental health agencies. We expected greater therapist financial strain to predict higher turnover and participation in a system-funded evidence-based practice (EBP) training initiative to alleviate this effect. Controlling for covariates, financial strain predicted therapist turnover (OR 1.12, p = .045), but not for therapists who participated in an EBP training initiative. Reducing financial strain and/or promoting EBP implementation may be levers to reduce turnover.
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Affiliation(s)
- Danielle R Adams
- School of Social Service Administration, University of Chicago, Chicago, IL, USA.,Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA
| | | | - Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA.,Hall-Mercer Community Mental Health Center, Philadelphia, PA, USA
| | - Laura Skriner
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA.,Evidence-Based Practitioners of New Jersey, Summit, NJ, USA
| | - Lauren Shaffer
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA.,University of Texas, Southwestern, TX, Dallas, USA
| | - Kathryn DeWitt
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA.,Qualtrics, Provo, UT, USA
| | | | | | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA. .,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA.
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48
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Rodriguez A, Kim JJ, Zhan C, Lau AS, Hamilton AB, Palinkas LA, Gellatly R, Brookman-Frazee L. A Mixed-Method Analysis on the Impacts of a System-Driven Implementation of Multiple Child Evidence-Based Practices on Community Mental Health Providers. ACTA ACUST UNITED AC 2020; 52:67-79. [PMID: 34349341 DOI: 10.1037/pro0000353] [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: 11/08/2022]
Abstract
Initiatives to scale up evidence-based practices (EBPs) in routine care are likely to have myriad impacts on community providers, but these impacts have not yet been examined in depth. This is especially true within the context of simultaneous implementation of multiple evidence-based practices. The aim of this study was to characterize the multifaceted impacts on community mental health therapists within a system-driven implementation of multiple EBPs for youth and families. Semistructured interview and survey data were gathered from 60 therapists at 11 agencies contracted with the Los Angeles County Department of Mental Health to deliver EBPs within the Prevention and Early Intervention initiative. Therapists' accounts of impacts varied, and were either predominately negative, predominantly positive, or mixed-valence. Mixed-methods analyses using Kruskal-Wallis tests showed therapist valence groups varied on mean levels of self-reported burnout on surveys. Themes from qualitative data revealed several favorable (e.g., increased EBP knowledge, structure) and unfavorable (e.g., distress, feeling constrained by EBPs) impacts of county-contracted EBP implementation. These findings inform the development and implementation of future system-driven EBP initiatives that consider therapist perspective to optimize positive impacts and minimize negative impacts on therapists.
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Affiliation(s)
| | | | | | | | | | | | | | - Lauren Brookman-Frazee
- University of California, San Diego and San Diego State University/University of California, San Diego
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49
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Impact of Supervisory Support on Turnover Intention: The Mediating Role of Burnout and Job Satisfaction in a Longitudinal Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:488-497. [PMID: 30810850 DOI: 10.1007/s10488-019-00927-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
High rates of provider turnover are problematic for our mental health system. Research indicates that supervisory support could alleviate some turnover intention by decreasing emotional exhaustion (a key component of burnout) as well as by increasing job satisfaction. However, the potential mediation mechanisms have not been rigorously tested. Longitudinal data collected from 195 direct clinical care providers at two community mental health centers identified positive effects of supervisory support on reduced turnover intention through reduced emotional exhaustion. Job satisfaction was not a significant mediator. Supervisory support may help mitigate turnover intention through work-related stress reduction.
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50
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Dorsey S, Lucid L, Martin P, King KM, O’Donnell K, Murray LK, Wasonga AI, Itemba DK, Cohen JA, Manongi R, Whetten K. Effectiveness of Task-Shifted Trauma-Focused Cognitive Behavioral Therapy for Children Who Experienced Parental Death and Posttraumatic Stress in Kenya and Tanzania: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77:464-473. [PMID: 31968059 PMCID: PMC6990668 DOI: 10.1001/jamapsychiatry.2019.4475] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE Approximately 140 million children worldwide have experienced the death of one or both parents. These children, mostly in low- and middle-income countries, have higher rates of mental health problems than those who have not experienced parental death. Cognitive behavioral therapy (CBT) may improve the well-being of these children, but to our knowledge there have been no randomized clinical trials specifically focused on this population. OBJECTIVES To test the effectiveness of trauma-focused CBT (TF-CBT) for improving posttraumatic stress (PTS) in children in Kenya and Tanzania who have experienced parental death, to test the effects of TF-CBT on other mental health symptoms, and to examine the feasibility of task-shifting with greater reliance on experienced, local lay counselors as trainers and supervisors. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial conducted in urban and rural areas of Tanzania and Kenya compared TF-CBT and usual care (UC) for 640 children aged 7 to 13 years who were recruited from February 13, 2013, to July 24, 2015. All children had experienced the death of one or both parents and had elevated PTS and/or prolonged grief. Interviewers were masked to study condition. Participants were followed up for 12 months after the randomized clinical trial. Statistical analysis was performed from February 3, 2017, to August 26, 2019. All analyses were on an intent-to-treat basis. INTERVENTIONS In the intervention condition, 320 children received 12 weeks of group TF-CBT delivered by lay counselors who were supervised weekly. In the UC condition, 320 children received community services typically offered to this population. MAIN OUTCOMES AND MEASURES The primary outcome was PTS, evaluated using a continuous, standardized measure. Other mental health symptoms and child-guardian relationship were also measured. RESULTS A total of 640 children (320 girls and 320 boys; mean [SD] age, 10.6 [1.6] years) were included in the study. Trauma-focused CBT was more effective than UC for PTS in 3 of 4 sites after treatment (end of 3-month randomized clinical trial): rural Kenya (Cohen d = 1.04 [95% CI, 0.72-1.36]), urban Kenya (Cohen d = 0.56 [95% CI, 0.29-0.83]), and urban Tanzania (Cohen d = 0.45 [95% CI, 0.10-0.80]). At 12-month follow-up, TF-CBT remained more effective than UC in both rural (Cohen d = 0.86 [95% CI, 0.64-1.07]) and urban (Cohen d = 0.99 [95% CI, 0.75-1.23]) Kenya. At 12-month follow-up in Tanzania, children who received TF-CBT and UC had comparable rates of improvement (rural Tanzania, Cohen d = 0.09 [95% CI, -0.08 to 0.26]; urban Tanzania, Cohen d = 0.11 [95% CI, -0.09 to 0.31]). A similar pattern was seen for secondary outcomes, with stronger effects observed in Kenya, where children experienced greater stress and adversity (eg, more food scarcity, poorer guardian health, and greater exposure to traumatic events). CONCLUSIONS AND RELEVANCE This study found that TF-CBT was more effective than UC in reducing PTS among children who experienced parental death in 3 of 4 sites in Kenya and Tanzania. At 12-month follow-up, TF-CBT was more effective in reducing PTS only among children in rural and urban Kenya. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01822366.
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Affiliation(s)
- Shannon Dorsey
- Department of Psychology, University of
Washington, Seattle
| | - Leah Lucid
- Department of Psychology, University of
Washington, Seattle
| | - Prerna Martin
- Department of Psychology, University of
Washington, Seattle
| | - Kevin M. King
- Department of Psychology, University of
Washington, Seattle
| | - Karen O’Donnell
- Center for Child and Family Health, Duke
University, Durham, North Carolina
| | - Laura K. Murray
- Department of Mental Health and International
Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Judith A. Cohen
- Department of Psychiatry, Allegheny Health
Network, Drexel University College of Medicine, Pittsburgh, Pennsylvania
| | - Rachel Manongi
- Institute of Public Health, Kilimanjaro
Christian Medical University College, Moshi, Tanzania
| | - Kathryn Whetten
- Center for Health Policy and Inequalities
Research, Sanford School of Public Policy and Duke Global Health Institute, Duke
University, Durham, North Carolina
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