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Waaler PM, Bergseth J, Vaskinn L, Espenes K, Holtan T, Kjøbli J, Bjørnebekk G. Identification of treatment elements for adolescents with callous unemotional traits: a systematic narrative review. Child Adolesc Psychiatry Ment Health 2024; 18:110. [PMID: 39227822 DOI: 10.1186/s13034-024-00792-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/31/2024] [Indexed: 09/05/2024] Open
Abstract
Adolescents with callous unemotional (CU) traits are at risk for poor quality-of-life outcomes such as incarceration, suicide, and psychopathy. It is currently unknown which treatments are implemented with CU adolescents specifically and which elements make up these interventions. A narrative systematic review was used to identify the treatments and common elements used with CU adolescents (12-18 years). Eligible studies were randomized controlled trials and quasi-experimental studies evaluating psychosocial interventions, delivered within a clinical context, and directed towards the adolescent or their family. Eight studies with 1291 participants were included. Significant decreases in CU traits were demonstrated only in a minority of studies. The most utilized practice elements were set goals for treatment, practice interpersonal/communication skills, prepare for termination, and teach parents skills and strategies; the most utilized process elements were formal therapy, practice exercises, important others, and flexible/adaptive. A majority of the studies did not report an implementation element. While theoretical frameworks for CU children are employed with CU adolescents, there is still uncertainty regarding their suitability for this age group. Given the limited empirical evidence, there is a critical need for further exploration.
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Affiliation(s)
- Pamela M Waaler
- Department of Special Needs Education, University of Oslo, Oslo, Norway.
| | - Josefine Bergseth
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Linda Vaskinn
- Norwegian Directorate for Children, Youth and Family Affairs (Bufdir), Oslo, Norway
| | - Kristin Espenes
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
- Norwegian Office for Children, Youth and Family Affairs (Bufetat), Oslo, Norway
| | - Thale Holtan
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - John Kjøbli
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
- Department of Education, University of Oslo, Oslo, Norway
| | - Gunnar Bjørnebekk
- Department of Special Needs Education, University of Oslo, Oslo, Norway
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Helland SS, Vira EG, Kjøbli J, Røysamb E, Nes RB, Kaasbøll J, Baardstu S. What Emotion Regulation Strategies are Associated with a General Psychopathology Factor (p) in Adolescence? Identifying Possible Transdiagnostic Targets for Intervention. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01239-0. [PMID: 39196309 DOI: 10.1007/s10802-024-01239-0] [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: 08/08/2024] [Indexed: 08/29/2024]
Abstract
Mental health problems in adolescence are increasing and there is an urgent call for transdiagnostic interventions, as most adolescents experience problems across multiple domains. Research has identified a general psychopathology factor (p) capturing the shared variance across mental health problems. In parallel, there is empirical support for the transdiagnostic nature of emotion regulation. In the current study, we explore the associations between p and emotion regulation strategies to identify which strategies may be promising targets for intervention. Data from the population-based Youth and Mental Health Study (YAMHS) (N = 2,464, mean age 13.7 years, SD 0.6) was used. The fit of different structural models of emotion regulation and psychopathology were compared, and latent factors from the final models were included in multiple regression analyses to explore the associations between p and emotion regulation strategies. A bifactor exploratory structural equation model (B-ESEM) showed best fit for modelling p. For emotion regulation strategies, an ESEM model showed best fit, including Rumination, Reactive Impulsivity, Distraction, Non-Acceptance, Problem Solving, Social Support, and Proactive Behavior. Results showed that a higher score on p was predicted by higher scores on the emotion regulation strategies Rumination (β = .38, p < .001) and Reactive Impulsivity (β = .35, p < .001), and lower scores on Problem Solving (β = -.15, p < .001). The results indicate that Rumination and Reactive Impulsivity have the strongest associations with p and may be promising targets for mental health interventions for adolescents.
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Affiliation(s)
| | - Emily Gabriela Vira
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Promenta Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - John Kjøbli
- Regional Center for Child and Adolescent Mental Health, Oslo, Norway
- Institute of Education, University of Oslo, Oslo, Norway
| | - Espen Røysamb
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Promenta Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Ragnhild Bang Nes
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Promenta Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Jannike Kaasbøll
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Health Research, SINTEF Digital, Trondheim, Norway
| | - Silje Baardstu
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
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Yang Y(S, Law M, Vaghri Z. New Brunswick's mental health action plan: A quantitative exploration of program efficacy in children and youth using the Canadian Community Health Survey. PLoS One 2024; 19:e0301008. [PMID: 38848408 PMCID: PMC11161078 DOI: 10.1371/journal.pone.0301008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/09/2024] [Indexed: 06/09/2024] Open
Abstract
In 2011, the New Brunswick government released the New Brunswick Mental Health Action Plan 2011-2018 (Action Plan). Following the release of the Action Plan in 2011, two progress reports were released in 2013 and 2015, highlighting the implementation status of the Action Plan. While vague in their language, these reports indicated considerable progress in implementing the Action Plan, as various initiatives were undertaken to raise awareness and provide additional resources to facilitate early prevention and intervention in children and youth. However, whether these initiatives have yielded measurable improvements in population-level mental health outcomes in children and youth remains unclear. The current study explored the impact of the Action Plan by visualizing the trend in psychosocial outcomes and service utilization of vulnerable populations in New Brunswick before and after the implementation of the Action Plan using multiple datasets from the Canadian Community Health Survey. Survey-weighted ordinary least square regression analyses were performed to investigate measurable improvements in available mental health outcomes. The result revealed a declining trend in the mental wellness of vulnerable youth despite them consistently reporting higher frequencies of mental health service use. This study highlights the need for a concerted effort in providing effective mental health services to New Brunswick youth and, more broadly, Canadian youth, as well as ensuring rigorous routine outcome monitoring and evaluation plans are consistently implemented for future mental health strategies at the time of their initiation.
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Affiliation(s)
- Yuzhi (Stanford) Yang
- Department of Psychology, Faculty of Science, Applied Science, and Engineering, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Moira Law
- Department of Psychology, Faculty of Science, St. Mary’s University, Halifax, Nova Scotia, Canada
| | - Ziba Vaghri
- Global Child Program, Integrated Health Initiative, Faculty of Business, University of New Brunswick, Saint John, New Brunswick, Canada
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Saccaro LF, Giff A, De Rossi MM, Piguet C. Interventions targeting emotion regulation: A systematic umbrella review. J Psychiatr Res 2024; 174:263-274. [PMID: 38677089 DOI: 10.1016/j.jpsychires.2024.04.025] [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: 09/30/2023] [Revised: 03/12/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Emotion dysregulation (ED), the difficulty in modulating which emotions are felt, and when and how they are expressed or experienced, has been implicated in an array of psychological disorders. Despite potentially different manifestations depending on the disorder, this symptom is emerging as a transdiagnostic construct that can and should be targeted early, given the associations with various maladaptive behaviors as early as childhood and adolescence. As such, our goal was to investigate the psychotherapeutic interventions used to address ED and gauge their effectiveness, safety, and potential mechanisms across various populations. METHODS This umbrella systematic review, pre-registered under PROSPERO (registration: CRD42023411452), consolidates evidence from systematic reviews and meta-analyses on psychotherapeutic interventions targeting ED, in accordance with PRISMA guidelines. RESULTS Our synthesis of quantitative and qualitative evidence from 21 systematic reviews (including 11 meta-analyses) points-with moderate overall risk of bias-to the effectiveness of Dialectical Behavior Therapy and Cognitive Behavioral Therapy in reducing ED in a wide range of adult transdiagnostic psychiatric patients and healthy participants. Similar results have emerged in other less extensively researched methods as well. However, results on adolescents and children are sparse, highlighting the need for additional research to tailor these interventions to the unique challenges of ED in younger populations with diverse externalizing and internalizing disorders. CONCLUSIONS These demonstrated transdiagnostic advantages of psychotherapy for ED underscore the potential for specifically designed interventions that address this issue directly, particularly for high-risk individuals. In these individuals, early interventions targeting transdiagnostic core dimensions may mitigate the emergence of full-blown disorders. Future research on the mediating factors, the durability of intervention effects, and the exploration of understudied interventions and populations may enhance prevention and treatment efficiency, enhancing the quality of life for those affected by varied manifestations of ED.
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Affiliation(s)
- Luigi F Saccaro
- Psychiatry Department, Geneva University Hospital, Switzerland; Psychiatry Department, Faculty of Medicine, University of Geneva, Switzerland.
| | | | - Maurilio Menduni De Rossi
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, Pisa 56127, Italy; Faculty of Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Camille Piguet
- Psychiatry Department, Geneva University Hospital, Switzerland; Psychiatry Department, Faculty of Medicine, University of Geneva, Switzerland
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Thomson A, Lawrence EG, Oliver BR, Wright B, Hosang GM. Self-directed digital interventions for the improvement of emotion regulation-effectiveness for mental health and functioning in adolescents: protocol for a systematic review. BMJ Open 2024; 14:e081556. [PMID: 38658015 PMCID: PMC11043735 DOI: 10.1136/bmjopen-2023-081556] [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: 10/31/2023] [Accepted: 02/29/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Research suggests that problems with emotion regulation, that is, how a person manages and responds to an emotional experience, are related to a range of psychological disorders (eg, bipolar disorder, anxiety and depression). Interventions targeting emotion regulation have been shown to improve mental health in adults, but evidence on related interventions for adolescents is still emerging. Increasingly, self-directed digital interventions (eg, mobile apps) are being developed to target emotion regulation in this population, but questions remain about their effectiveness. This systematic review aimed to synthesise evidence on current self-directed digital interventions available to adolescents (aged 11-18 years) and their effectiveness in addressing emotion regulation, psychopathology and functioning (eg, academic achievement). METHODS AND ANALYSIS Several electronic databases will be searched (eg, MEDLINE, PsycINFO, ACM Digital Library) to identify all studies published any time after January 2010 examining self-directed digital interventions for adolescents, which include an emotion regulation component. This search will be updated periodically to identify any new relevant research from the selected databases. Data on the study characteristics (eg, author(s)) and methodology, participant characteristics (eg, age) and the digital interventions used to address emotion (dys-)regulation (eg, name, focus) will be extracted. A narrative synthesis of all studies will be presented. If feasible, the effectiveness data will be synthesised using appropriate statistical techniques. The methodological quality of the included studies will be assessed with the Effective Public Health Practice Project quality assessment tool. ETHICS AND DISSEMINATION Ethical approval is not required for this study. Findings will be disseminated widely via peer-reviewed publications and presentations at conferences related to this field. REGISTRATION DETAILS PROSPERO CRD42022385547.
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Affiliation(s)
- Abigail Thomson
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Erin G Lawrence
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Bonamy R Oliver
- UCL Institute of Education, University College London, London, UK
| | - Ben Wright
- East London NHS Foundation Trust, London, UK
- City University of London, London, UK
| | - Georgina M Hosang
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Iannattone S, Mezzalira S, Bottesi G, Gatta M, Miscioscia M. Emotion dysregulation and psychopathological symptoms in non-clinical adolescents: The mediating role of boredom and social media use. Child Adolesc Psychiatry Ment Health 2024; 18:5. [PMID: 38184635 PMCID: PMC10771649 DOI: 10.1186/s13034-023-00700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/27/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Emotion dysregulation, boredom, and problematic social media use are well-known vulnerability factors for psychopathology during adolescence; nevertheless, the interplay between these factors remains underinvestigated in the literature. Therefore, the present cross-sectional study aimed to explore the mediating role of boredom and problematic social media use in the relations between emotion dysregulation and both internalizing and externalizing problems in a non-clinical group of Italian adolescents. METHOD 721 students (64.6% girls; Mage = 15.49 years ± 1.82) were involved and completed self-report tools assessing emotion dysregulation, boredom, problematic social media use, and psychopathological symptoms. Path analysis was used to test whether boredom and problematic social media use mediated the relation between emotion dysregulation and psychopathology, distinguishing between internalizing and externalizing problems. RESULTS Path models showed that emotion dysregulation predicted both internalizing and externalizing problems, as well as boredom and problematic social media use. Importantly, boredom mediated the associations between emotion dysregulation and both psychopathological dimensions, while problematic social media use mediated only the relation with externalizing problems. CONCLUSIONS Our results highlight that the influence of emotion dysregulation on psychopathology can manifest through different paths, leading to specific symptomatology based on interactions between various variables. In particular, boredom seems to be a transdiagnostic factor for psychopathology in adolescence, whereas problematic social media use would be a dimension-specific factor. The practical implications of these findings are discussed.
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Affiliation(s)
- Sara Iannattone
- Department of General Psychology, University of Padua, via Venezia 8, Padua, 35131, Italy.
| | - Selene Mezzalira
- Department of Engineering, University of Basilicata, Potenza, Italy
| | - Gioia Bottesi
- Department of General Psychology, University of Padua, via Venezia 8, Padua, 35131, Italy
| | - Michela Gatta
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Marina Miscioscia
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
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Rognstad K, Engell T, Fjermestad K, Wentzel-Larsen T, Kjøbli J. Process and Implementation Elements of Measurement Feedback Systems: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023:10.1007/s10488-023-01325-3. [PMID: 38153585 DOI: 10.1007/s10488-023-01325-3] [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: 11/18/2023] [Indexed: 12/29/2023]
Abstract
Measurement feedback systems (MFS) can help guide treatment and improve clinical outcomes. Studies of MFS are heterogeneous both in execution and results, and the effects of MFS seem restricted by limited attention to process and implementation elements and by limited adoption by health professionals. The current systematic review mapped the use of process and implementation elements in MFS studies. An overview of therapists' use of and attitudes toward MFS is provided. Three-level meta-analyses were used to test theoretically informed process and implementation elements as moderators of the effects of MFS. Hypotheses and general propositions from Clinical Performance Feedback Intervention Theory (CP-FIT) were used to organize the elements of the studies and were used as moderator variables. Previous studies on MFS interventions have had a limited focus on implementation efforts and process elements that may increase the effects of MFS and their use among therapists. Efforts have sparsely been made to reduce barriers to MFS use, and several studies have reported limited engagement with MFS among therapists. Therapists' attitudes toward MFS, feedback, or standardized measures were heterogeneously reported, making data synthesis challenging. Identified process and implementation elements were not significantly associated with effect sizes in the studies and the results did not support the propositions of CP-FIT. The lack of statistically significant associations may be due to limited reporting of details about process and implementation aspects. More research designed to test hypotheses regarding process and implementation elements is needed to improve the use and effects of MFS. Future studies should aspire to report findings in a manner that allows for an understanding of the implementation process and therapists' adoption of these systems.
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Affiliation(s)
- Kristian Rognstad
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.
- Department of Psychology, University of Oslo, Oslo, Norway.
| | - Thomas Engell
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | | | - Tore Wentzel-Larsen
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - John Kjøbli
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
- Department of Education, University of Oslo, Oslo, Norway
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Iuga IA, David OA, Danet M. Student Burnout in Children and Adolescents: The Role of Attachment and Emotion Regulation. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1443. [PMID: 37761404 PMCID: PMC10527975 DOI: 10.3390/children10091443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
In an effort to explain the factors contributing to the development of student burnout, a construct that has received attention in relation to academic outcomes, including burnout, is emotion regulation. Further, attachment theory has been used to explore the variations in the use of particular emotion regulation strategies, and attachment has received support as a contributing factor. The aim of the study is to explore the role of attachment security and emotion regulation strategies associated with student burnout symptoms in a sample of 602 Romanian children and adolescents (55% female) aged 8-16 (M = 10.45) from 18 schools. A secondary objective was to explore the gender differences in burnout symptoms. The results show that attachment security negatively predicts student burnout symptoms. Further, a higher attachment security positively predicts the use of adaptive emotion regulation strategies, which, in turn, are negatively related to student burnout. Emotion regulation strategies mediate the relationship between attachment and burnout symptoms. No gender differences have been identified. The study has practical implications for both parents and specialists, bringing to attention the importance of secure attachment in children, which could further encourage the use of adaptive emotion regulation strategies.
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Affiliation(s)
- Ioana Alexandra Iuga
- Evidence-Based Psychological Assessment and Interventions Doctoral School, Babeş-Bolyai University, No. 37 Republicii Street, 400015 Cluj-Napoca, Romania;
- DATA Lab, The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babes-Bolyai University, No. 37 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Oana Alexandra David
- DATA Lab, The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babes-Bolyai University, No. 37 Republicii Street, 400015 Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, No. 37 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Marie Danet
- Department of Psychology, University of Lille, No. 42 Paul Duez Street, 59000 Lille, France;
- University of Lille, ULR 4072—PSITEC—Psychologie: Interactions, Temps, Emotions, Cognitions, 59000 Lille, France
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Engell T, Stadnick NA, Aarons GA, Barnett ML. Common Elements Approaches to Implementation Research and Practice: Methods and Integration with Intervention Science. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2023; 3:1-15. [PMID: 37013068 PMCID: PMC10063479 DOI: 10.1007/s43477-023-00077-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/05/2023] [Indexed: 04/03/2023]
Abstract
We propose that common elements approaches can advance implementation research and practice and facilitate pragmatic use of intervention and implementation evidence. Common elements are practices or processes frequently shared by interventions or implementations. Traditional common elements methodologies use synthesis, distillation, and statistics to describe and evaluate the merit of common ingredients in effective interventions. Recent developments include identifying and testing common configurations of elements, processes, and context variables across the literature of effective interventions and implementations. While common elements thinking has grown popular in intervention science, it has rarely been utilized in implementation science, and specifically, combined with the intervention literature. The goals of this conceptual methodology paper are to (1) provide an overview of the common elements concept and how it may advance implementation research and usability for practice, (2) give a step-by-step guide to systematic common elements reviews that synthesizes and distills the intervention and implementation literature together, and (3) offer recommendations for advancing element-level evidence in implementation science. A narrative review of the common elements literature was conducted with attention to applications to implementation research. A six-step guide to using an advanced common elements methodology was provided. Examples of potential results are presented, along with a review of the implications for implementation research and practice. Finally, we reviewed methodological limitations in current common elements approaches, and identified steps towards realizing their potential. Common elements methodologies can (a) synthesize and distill the implementation science literature into practical applications, (b) generate evidence-informed hypotheses about key elements and determinants in implementation and intervention processes and mechanisms, and (c) promote evidence-informed precision tailoring of intervention and implementation to context. To realize this potential, common elements approaches need improved reporting of details from both successful and unsuccessful intervention and implementation research, more data availability, and more testing and investigation of causal processes and mechanisms of change from diverse theories. Supplementary Information The online version contains supplementary material available at 10.1007/s43477-023-00077-4.
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Affiliation(s)
- Thomas Engell
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaugveien 1-3, 0484 Oslo, Norway
| | - Nicole A. Stadnick
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093 USA
- Child and Adolescent Services Research Center, San Diego, CA 92123 USA
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA 92093 USA
| | - Gregory A. Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093 USA
- Child and Adolescent Services Research Center, San Diego, CA 92123 USA
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA 92093 USA
| | - Miya L. Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, CA 93106-9490 USA
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