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Cordony I, Mills L, Mammen K, Lintzeris N. A systematic review on the effect of routine outcome monitoring and feedback on client outcomes in alcohol and other drug treatment. Drug Alcohol Rev 2023; 42:1701-1722. [PMID: 37654103 DOI: 10.1111/dar.13742] [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] [Received: 09/14/2022] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023]
Abstract
ISSUES Routine outcome monitoring (ROM) involves regularly measuring clients' outcomes during treatment, which can then be fed back to clinicians and/or clients. In the mental health field, ROM and feedback have been shown to improve client outcomes; however, no systematic reviews have examined whether improvement is also seen in alcohol and other drug (AOD) treatment outcomes. This review examines whether feedback to clients and/or clinicians of ROM data in AOD treatment improves future client outcomes. APPROACH This systematic review of papers identified in Medline, PsycInfo and Scopus examines the effect on client outcomes of feeding back ROM data to clinicians and/or clients in AOD treatment settings. Key client outcomes included substance use, treatment attendance and wellbeing measures. KEY FINDINGS Ten studies were included-five randomised controlled trials and five pre-post within-subjects designs. Six studies were deemed good- or fair-quality. Of these six, three provided feedback to clinicians only, one to clients only, and two to both clients and clinicians. Only one of the six found feedback was associated with significant reductions in substance use and only among off-track clients. Four of the six found feedback improved other outcomes, including treatment retention, global functioning, therapeutic alliance and mood symptoms. CONCLUSIONS There may be some positive effects for clients of providing feedback to clients and/or clinicians; however, the small number of randomised trials and the heterogeneity of methods, outcome measures and findings, mean that firm conclusions cannot be drawn about the efficacy of feedback until larger randomised studies are conducted.
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Affiliation(s)
- India Cordony
- School of Medicine, The University of Sydney, Sydney, Australia
| | - Llewellyn Mills
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, Australia
- Specialty of Addiction Medicine, Faculty Medicine and Health, The University of Sydney, Sydney, Australia
- NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Kristie Mammen
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, Australia
- NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, Australia
- Specialty of Addiction Medicine, Faculty Medicine and Health, The University of Sydney, Sydney, Australia
- NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
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van Sonsbeek MAMS, Hutschemaekers GJM, Veerman JW, Vermulst A, Tiemens BG. The results of clinician-focused implementation strategies on uptake and outcomes of Measurement-Based Care (MBC) in general mental health care. BMC Health Serv Res 2023; 23:326. [PMID: 37005612 PMCID: PMC10067297 DOI: 10.1186/s12913-023-09343-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/27/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Measurement-Based Care (MBC) is the routine administration of measures, clinicians' review of the feedback and discussion of the feedback with their clients, and collaborative evaluation of the treatment plan. Although MBC is a promising way to improve outcomes in clinical practice, the implementation of MBC faces many barriers, and its uptake by clinicians is low. The purpose of this study was to investigate whether implementation strategies that were developed with clinicians and aimed at clinicians had an effect on (a) clinicians' uptake of MBC and (b) clients' outcomes of MBC. METHODS We used an effectiveness-implementation hybrid design based on Grol and Wensing's implementation framework to assess the impact of clinician-focused implementation strategies on both clinicians' uptake of MBC and outcomes obtained with MBC for clients in general mental health care. We hereby focused on the first and second parts of MBC, i.e., the administration of measures and use of feedback. Primary outcome measures were questionnaire completion rate and discussion of the feedback with clients. Secondary outcomes were treatment outcome, treatment length, and satisfaction with treatment. RESULTS There was a significant effect of the MBC implementation strategies on questionnaire completion rate (one part of clinicians' uptake), but no significant effect on the amount of discussion of the feedback (the other part of clinicians' uptake). Neither was there a significant effect on clients' outcomes (treatment outcome, treatment length, and satisfaction with treatment). Due to various study limitations, the results should be viewed as exploratory. CONCLUSIONS Establishing and sustaining MBC in real-world general mental health care is complex. This study helps to disentangle the effects of MBC implementation strategies on differential clinician uptake, but the effects of MBC implementation strategies on client outcomes need further examination.
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Affiliation(s)
| | - Giel J M Hutschemaekers
- Pro Persona Research, Pro Persona, Postbus 27, 6870 AA, Renkum, The Netherlands
- Indigo Gelderland, Indigo Service Organisatie BV, Utrecht, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Jan W Veerman
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Ad Vermulst
- GGZ (Mental Health Care) Oost Brabant, Boekel, The Netherlands
| | - Bea G Tiemens
- Pro Persona Research, Pro Persona, Postbus 27, 6870 AA, Renkum, The Netherlands
- Indigo Gelderland, Indigo Service Organisatie BV, Utrecht, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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Hallgren KA, Cohn EB, Ries RK, Atkins DC. Delivering Remote Measurement-Based Care in Community Addiction Treatment: Engagement and Usability Over a 6-Month Clinical Pilot. Front Psychiatry 2022; 13:840409. [PMID: 35463505 PMCID: PMC9021526 DOI: 10.3389/fpsyt.2022.840409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Measurement-based care (MBC) is an evidence-based practice in which patients routinely complete standardized measures throughout treatment to help monitor clinical progress and inform clinical decision-making. Despite its potential benefits, MBC is rarely used in community-based substance use disorder (SUD) treatment. In this pilot study, we evaluated the feasibility of incorporating a digital and remotely delivered MBC system into SUD treatment within a community setting by characterizing patients' and clinicians' engagement with and usability ratings toward the MBC system that was piloted. Methods A pilot study was conducted with 30 patients receiving SUD treatment and eight clinicians providing SUD treatment in a large, publicly funded addiction and mental health treatment clinic. Services as usual within the clinic included individual psychotherapy, case management, group therapy, peer support, and medication management for mental health and SUD, including buprenorphine. Patients who enrolled in the pilot continued to receive services as usual and were automatically sent links to complete a 22-item questionnaire, called the weekly check-in, via text message or email weekly for 24 weeks. Results of the weekly check-in were summarized on a clinician-facing web-based dashboard. Engagement was characterized by calculating the mean number of weekly check-ins completed by patients and the mean number times clinicians logged into the MBC system. Ratings of the MBC system's usability and clinical utility were provided by patients and clinicians. Results Patient participants (53.3% male, 56.7% white, 90% Medicaid enrolled) completed a mean of 20.60 weekly check-ins (i.e., 85.8% of the 24 expected per patient). All but one participating clinician with a patient enrolled in the study logged into the clinician-facing dashboard at least once, with an average of 12.20 logins per clinician. Patient and clinician ratings of usability and clinical utility were favorable: most patients agreed with statements that the weekly check-in was easy to navigate and aided self-reflection. All clinicians who completed usability questionnaires agreed with statements indicating that the dashboard was easy to navigate and that it provided meaningful information for SUD treatment. Conclusions A digital and remotely delivered MBC system can yield high rates of patient and clinician engagement and high ratings of usability and clinical utility when added into SUD treatment as usual. The success of this clinical pilot may be attributable, in part, to the user-centered design processes that were used to develop and refine the MBC system that was piloted. Future efforts may focus on strategies to test whether MBC can be sustainably implemented and offers clinical benefits to patients in community SUD treatment settings.
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Affiliation(s)
- Kevin A. Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Van Horn DHA, Goodman J, Lynch KG, Bonn-Miller MO, Thomas T, Del Re AC, Babson K, McKay JR. The predictive validity of the progress assessment, a clinician administered instrument for use in measurement-based care for substance use disorders. Psychiatry Res 2020; 292:113282. [PMID: 32711168 PMCID: PMC9434595 DOI: 10.1016/j.psychres.2020.113282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 12/01/2022]
Abstract
We tested the predictive validity of the Progress Assessment (PA), a brief counselor administered tool for use in measurement-based care for substance use disorders. The PA includes 5 items assessing relapse risk and 5 items assessing factors protective against relapse. Data were drawn from a completed study of continuing care for cocaine dependence (McKay et al., 2013) and includes 12 months of follow-up on158 participants (76% male) who received brief telephone or face-to-face sessions. Each session began with the administration of the PA, followed by cognitive-behavioral counseling tied to the results of the PA and anticipated risky situations. Outcome was assessed via urine toxicology every 3 months. As administered in an effectiveness trial, average PA risk and protective scales within each 3-month segment of the study predicted urine toxicology results at the end of that period, with higher risk scores and lower protective scores predicting greater rates of cocaine positive urine drug screens. PA scores did not predict dropout from continuing care participation. The 10-item PA shows promise as a pragmatic clinical tool for ongoing monitoring during continuing care for substance dependence.
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Affiliation(s)
- Deborah H. A. Van Horn
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine; 3535 Market St, Philadelphia, PA 19104 USA,Corresponding author: Deborah H. A. Van Horn; voice: 856-905-5261; fax: 856-845-9081;
| | - Jessica Goodman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine; 3535 Market St, Philadelphia, PA 19104 USA,Center of Excellence in Substance Abuse Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104 USA
| | - Kevin G. Lynch
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine; 3535 Market St, Philadelphia, PA 19104 USA
| | - Marcel O. Bonn-Miller
- Center of Excellence in Substance Abuse Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104 USA,National Center for PTSD-Dissemination & Training Division, VA Palo Alto Health Care System; 795 Willow Rd., Menlo Park, CA 94025 USA,Center for Innovation to Implementation, VA Palo Alto Health Care System; 795 Willow Rd., Menlo Park, CA 94025 USA
| | - Tyrone Thomas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine; 3535 Market St, Philadelphia, PA 19104 USA
| | - AC Del Re
- Center for Innovation to Implementation, VA Palo Alto Health Care System; 795 Willow Rd., Menlo Park, CA 94025 USA
| | - Kimberly Babson
- National Center for PTSD-Dissemination & Training Division, VA Palo Alto Health Care System; 795 Willow Rd., Menlo Park, CA 94025 USA
| | - James R. McKay
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine; 3535 Market St, Philadelphia, PA 19104 USA,Center of Excellence in Substance Abuse Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104 USA
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Fadus MC, Squeglia LM, Valadez EA, Tomko RL, Bryant BE, Gray KM. Adolescent Substance Use Disorder Treatment: an Update on Evidence-Based Strategies. Curr Psychiatry Rep 2019; 21:96. [PMID: 31522280 PMCID: PMC7241222 DOI: 10.1007/s11920-019-1086-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW To examine the most recent published evidence (2016-2019) regarding the treatment of adolescent substance use disorders and to provide an update on evidence-based strategies, adjunctive interventions, and methods to improve currently established treatment approaches. RECENT FINDINGS Recent evidence suggests that psychosocial treatments such as family-based therapy, cognitive behavioral therapy, and multicomponent approaches remain the most effective methods of treatment; however, innovative ways of improving these treatment strategies may include digital and culturally based interventions. New advances in adjunctive treatments such as pharmacotherapy, exercise, mindfulness, and recovery-oriented educational centers may have some clinical utility. Well-established psychosocial interventions remain the primary modality of treatment. Promising new adjunctive treatments and improvements in our currently established treatments may yield significant improvements.
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Affiliation(s)
- Matthew C Fadus
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA.
| | - Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
| | - Emilio A Valadez
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
| | - Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
| | - Brittany E Bryant
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
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Djernis D, Lerstrup I, Poulsen D, Stigsdotter U, Dahlgaard J, O'Toole M. A Systematic Review and Meta-Analysis of Nature-Based Mindfulness: Effects of Moving Mindfulness Training into an Outdoor Natural Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173202. [PMID: 31480748 PMCID: PMC6747393 DOI: 10.3390/ijerph16173202] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 01/08/2023]
Abstract
Research has proven that both mindfulness training and exposure to nature have positive health effects. The purpose of this study was to systematically review quantitative studies of mindfulness interventions conducted in nature (nature-based mindfulness), and to analyze the effects through meta-analyses. Electronic searches revealed a total of 25 studies to be included, examining 2990 participants. Three analyses were conducted: Nature-based mindfulness interventions evaluated as open trials (k = 13), nature-based mindfulness compared with groups in non-active control conditions (k = 5), and nature-based mindfulness compared with similar interventions but without contact with nature (k = 7). The overall combined psychological, physiological, and interpersonal effects from pre- to post-intervention were statistically significant and of medium size (g = 0.54, p < 0.001). Moderation analyses showed that natural environments characterized as forests/wild nature obtained larger numerical effects than environments characterized as gardens/parks, as did informal mindfulness compared with formal mindfulness. The small number of studies included, as well as the heterogeneity and generally low quality of the studies, must be taken into consideration when the results are interpreted. PROSPERO registration number: CRD42017065639.
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Affiliation(s)
- Dorthe Djernis
- Department of Geoscience and Natural Resource Management, University of Copenhagen, C 1958 Frederiksberg, Denmark.
| | - Inger Lerstrup
- Department of Landscape Architecture and Management, Swedish University of Agricultural Sciences, 230 53 Alnarp, Sweden
| | - Dorthe Poulsen
- Department of Geoscience and Natural Resource Management, University of Copenhagen, C 1958 Frederiksberg, Denmark
| | - Ulrika Stigsdotter
- Department of Geoscience and Natural Resource Management, University of Copenhagen, C 1958 Frederiksberg, Denmark
| | - Jesper Dahlgaard
- Department of Clinical Medicine, Aarhus University,; N 8200 Aarhus, Denmark
- Research Center for Health and Welfare Technology, VIA University College, N 8200 Aarhus, Denmark
| | - Mia O'Toole
- Department of Psychology and Behavioural Sciences, Aarhus University, C 8000 Aarhus, Denmark
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