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Blackwell SE. Using the 'Leapfrog' Design as a Simple Form of Adaptive Platform Trial to Develop, Test, and Implement Treatment Personalization Methods in Routine Practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:686-701. [PMID: 38316652 PMCID: PMC11379800 DOI: 10.1007/s10488-023-01340-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/07/2024]
Abstract
The route for the development, evaluation and dissemination of personalized psychological therapies is complex and challenging. In particular, the large sample sizes needed to provide adequately powered trials of newly-developed personalization approaches means that the traditional treatment development route is extremely inefficient. This paper outlines the promise of adaptive platform trials (APT) embedded within routine practice as a method to streamline development and testing of personalized psychological therapies, and close the gap to implementation in real-world settings. It focuses in particular on a recently-developed simplified APT design, the 'leapfrog' trial, illustrating via simulation how such a trial may proceed and the advantages it can bring, for example in terms of reduced sample sizes. Finally it discusses models of how such trials could be implemented in routine practice, including potential challenges and caveats, alongside a longer-term perspective on the development of personalized psychological treatments.
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Affiliation(s)
- Simon E Blackwell
- Department of Clinical Psychology and Experimental Psychopathology, Georg-Elias-Mueller-Institute of Psychology, University of Göttingen, Kurze-Geismar-Str.1, 37073, Göttingen, Germany.
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Haug IM, Neumer SP, Handegård BH, Lisøy C, Rasmussen LMP, Bania EV, Adolfsen F, Patras J. Dose-Response Effects of MittEcho, a Measurement Feedback System, in an Indicated Mental Health Intervention for Children in Municipal and School Services in Norway. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01389-9. [PMID: 38809322 DOI: 10.1007/s10488-024-01389-9] [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: 05/11/2024] [Indexed: 05/30/2024]
Abstract
Including routine client feedback can increase the effectiveness of mental health interventions for children, especially when implemented as intended. Rate of implementation, or dose, of such feedback interventions has been shown to moderate results in some studies. Variation in implementation and use of client feedback may also contribute to the mixed results observed within the feedback literature. This study evaluates dose-response associations of client feedback using a novel Measurement Feedback System (MFS) within an indicated group intervention. The primary aim was to determine whether the rate of MFS implementation predicts symptom reduction in anxiety and depression among school-aged children. The secondary aim was to assess whether the rate of MFS implementation influences children's satisfaction with the group intervention or their dropout rates. Data were collected via a randomized factorial study (clinicaltrials.gov NCT04263558) across 58 primary schools in Norway. Children aged 8 to 12 years (N = 701) participated in a group-based, transdiagnostic intervention targeting elevated symptoms of anxiety or depression. Half of the child groups also received the feedback intervention using the MittEcho MFS. Group leaders (N = 83), recruited locally, facilitated the interventions. The MFS dose was measured using the Implementation Index, which combines the use of MFS by both children and providers (group leaders) into a single dose variable. Results showed no significant additional effect of dose of MFS on change in depression or anxiety scores, on user satisfaction with the intervention or on intervention dropout. The discussion addresses potential reasons for these non-significant findings and implications for MFS implementation in preventive, group-based interventions in school settings.
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Affiliation(s)
- Ida Mari Haug
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway.
| | - Simon-Peter Neumer
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Bjørn Helge Handegård
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
| | - Carina Lisøy
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Lene-Mari P Rasmussen
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
| | - Elisabeth Valmyr Bania
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frode Adolfsen
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
| | - Joshua Patras
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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