Therapist Attitudes Towards Evidence-Based Practice: A Joint Factor Analysis

Shared Decision-Making with Latinx Caregivers During Community Implemented Evidence-Based Practices: Determinants and Associations with Alliance

OBJECTIVE

The current observational study examined shared decision-making (SDM) with caregivers of Latinx youth within the delivery of multiple evidence-based practices (EBPs) in community mental health services. The aims of the study were to (1) Identify therapist and client factors associated with increased SDM within EBP sessions and (2) Examine the association between SDM and therapeutic alliance between community therapists and Latinx caregivers.

METHOD

The Observing Patient Involvement in Decision-Making (OPTION) instrument measured SDM in 210 audio-recorded therapy sessions with 62 community therapists (91.94% female; 69.35% Latinx) and 109 Latinx caregivers (91.43% female) of youth who were an average age of 8.26 years (SD = 3.59). We used the Therapy Process Observational Coding System for Child Psychotherapy-Alliance scale to measure the caregiver-therapist alliance observationally. Multilevel linear regressions were conducted to examine research questions.

RESULTS

Greater SDM was observed within sessions where therapists targeted conduct problems versus trauma (B = -8.79, 95% CI[-14.09, -3.49], p = .001). There was a trend that SDM was higher in English-language sessions compared to Spanish. We found that the global measurement of SDM (B = .04, 95% CI[.01, .08], p = .03) and the OPTION item Integrate Preferences (B = .69, 95% CI[.07, 1.32], p = .03) were positively associated with alliance.

CONCLUSIONS

SDM may help foster Latinx caregiver engagement within EBP delivery. Provider training in SDM may be warranted with consideration of the specific clinical contexts (e.g., by presenting problem) that are appropriate for collaborative treatment planning. More research is needed to further establish the benefits of SDM in youth psychotherapy.

Predictors of the sustainability for an evidence-based eating disorder prevention program delivered by college peer educators

BACKGROUND

Despite ongoing efforts to introduce evidence-based interventions (EBIs) into mental health care settings, little research has focused on the sustainability of EBIs in these settings. College campuses are a natural place to intervene with young adults who are at high risk for mental health disorders, including eating disorders. The current study tested the effect of three levels of implementation support on the sustainability of an evidence-based group eating disorder prevention program, the Body Project, delivered by peer educators. We also tested whether intervention, contextual, or implementation process factors predicted sustainability.

METHODS

We recruited 63 colleges with peer educator programs and randomly assigned them to (a) receive a 2-day Train-the-Trainer (TTT) training in which peer educators were trained to implement the Body Project and supervisors were taught how to train future peer educators (TTT), (b) TTT training plus a technical assistance (TA) workshop (TTT + TA), or (c) TTT plus the TA workshop and quality assurance (QA) consultations over 1-year (TTT + TA + QA). We tested whether implementation support strategies, perceived characteristics of the intervention and attitudes towards evidence-based interventions at baseline and the proportion of completed implementation activities during the implementation year predicted three school-level dichotomous sustainability outcomes (offering Body Project groups, training peer educators, training supervisors) over the subsequent two-year sustainability period using logistic regression models.

RESULTS

Implementation support strategies did not significantly predict any sustainability outcomes, although a trend suggested that colleges randomized to the TTT + TA + QA strategy were more likely to train new supervisors (OR = 5.46, 95% CI [0.89-33.38]). Colleges that completed a greater proportion of implementation activities were more likely to offer Body Project groups (OR = 1.53, 95% CI [1.19-1.98]) and train new peer educators during the sustainability phase (OR = 1.39, 95% CI [1.10-1.74]). Perceived positive characteristics of the Body Project predicted training new peer educators (OR = 18.42, 95% CI [1.48-299.66]), which may be critical for sustainability in routine settings with high provider turnover.

CONCLUSIONS

Helping schools complete more implementation activities and increasing the perceived positive characteristics of a prevention program may result in greater sustainment of prevention program implementation.

TRIAL REGISTRATION

This study was preregistered on 12/07/17 with ClinicalTrials.gov, ID NCT03409809, https://clinicaltrials.gov/ct2/show/NCT03409809 .

Setting and Provider Predictors of Implementation Success for an Eating Disorder Prevention Program Delivered by College Peer Educators

INTRODUCTION

College students face increased risk for a variety of mental health problems but experience barriers to treatment access. Prevention programs, including those implemented by peer educators, may decrease treatment needs and increase service access. We examined the implementation of an evidence-based eating disorder prevention program, Body Project, delivered by college peer educators at 63 colleges/universities, comparing three levels of implementation support: (1) Train-the-Trainer (TTT) training; (2) TTT plus a technical assistance workshop (TTT + TA); and (3) TTT + TA with one year of quality assurance calls (TTT + TA + QA). The present study tested the degree to which indicators proposed by the Consolidated Framework for Implementation Research (CFIR) were associated with core implementation outcomes.

METHOD

We tested whether indices of CFIR domains (i.e., perceived intervention characteristics, outer and inner setting factors, provider characteristics, and implementation process) were correlated with three implementation outcomes (program reach, fidelity, effectiveness) during a 1-year implementation period.

RESULTS

Greater program reach was associated with implementation process, specifically the completion of more implementation activities (β = 0.46). Greater program fidelity was associated with higher positive (β = 0.44) and lower negative (β = - 0.43) perceptions of the Body Project characteristics, and greater reported general support for evidence-based practices (β = 0.41). Greater effectiveness was associated with lower negative perceptions of Body Project characteristics (d = 0.49).

CONCLUSIONS

Several implementation determinants proposed by the CFIR model predicted outcomes, especially intervention fidelity. Across the outcomes of interest, implementation determinants related to peer educator and supervisor perceived characteristics of the specific intervention and general attitudes towards evidence-based practices emerged as robust predictors to inform future work investigating ongoing implementation and sustainability of programs in university settings.

Observed Engagement in Community Implemented Evidence-Based Practices for Children and Adolescents: Implications for Practice Delivery

OBJECTIVE

This observational study characterizes youth and caregiver behaviors that may pose challenges to engagement within a system-driven implementation of multiple evidence-based practices (EBPs). We examined links between Engagement Challenges and therapist EBP implementation outcomes.

METHOD

Community therapists (N = 102) provided audio recordings of EBP sessions (N = 666) for youth (N = 267; 71.54%, Latinx; 51.69%, female; Mage = 9.85, Range: 1-18). Observers rated the extent to which youth and/or caregivers engaged in the following behaviors: Caregiver and/or Youth Expressed Concerns about interventions, and Youth Disruptive Behaviors. Multilevel modeling was used to identify predictors of observable Engagement Challenges, and examine associations between Engagement Challenges, and therapist-reported ability to deliver planned activities, and observer-rated extensiveness of EBP strategy delivery.

RESULTS

At least one Engagement Challenge was observed in 43.99% of sessions. Youth Engagement Challenges were not associated with outcomes. Caregiver Expressed Concerns were negatively associated with therapist-reported ability to carry out planned session activities (B = -.21, 95% CI[-.39-(-.02)], p < .05). However, Caregiver Expressed Concerns were positively associated with extensiveness of EBP Content strategy delivery (B = .08, 95% CI[.01-.15], p < .05).

CONCLUSIONS

Results suggest that Youth Engagement Challenges have little observed impact on EBP delivery. In contrast, although therapists perceive that Caregiver Expressed Concerns derail their planned activities, Caregiver Expressed Concerns are associated with more extensive delivery of content about therapeutic interventions. Community therapists' implementation of EBPs appear unaffected by common youth in-session behavioral challenges, but future research is needed to clarify whether caregivers' concerns about interventions prompt, or are prompted by, more intensive therapist EBP content instruction.

Parent and clinician perspectives on virtual guided self-help family-based treatment (GSH-FBT) for adolescents with anorexia nervosa

PURPOSE

Guided self-help (GSH) treatments have the capacity to expand access to care, decrease costs, and increase dissemination compared to traditional therapist-directed treatment approaches. However, little is known about parent and clinician perspectives about the acceptability of GSH for adolescents with eating disorders.

METHODS

This study utilized a mixed methods approach to obtain qualitative and quantitative data regarding clinician and participants' experiences with GSH. Parent participants were enrolled in a randomized trial comparing GSH family-based treatment (GSH-FBT) to family-based treatment delivered via videoconferencing (FBT-V) for adolescents (12-18 years old) with a DSM-5 diagnosis of anorexia nervosa (AN). Parent participants provided qualitative feedback using the Helping Alliances Questionnaire about their experience of treatment. Clinician participants were six master's or PhD-level therapists. These clinicians were trained in and provided both treatments (GSH-FBT and FBT-V). They provided responses to questionnaires and participated in a 1-h focus group about their experience as treatment providers.

RESULTS

Regardless of treatment condition, parents listed more improvement than worsening of symptoms in their child with AN. Clinicians reported lower scores on competency and comfort metrics with GSH-FBT compared to FBT-V. Qualitatively, clinicians reported both advantages and disadvantages of delivering GSH-FBT.

CONCLUSION

Further studies are needed to better understand how GSH interventions can be disseminated to patients and families, particularly those with limited access to specialized eating disorder treatment centers. Level of evidence Level I, data collected as part of a randomized controlled trial.

Attitudes Towards Evidence-Based Practice of Professionals Working with Children and Adolescents with Autism Spectrum Disorder in Bangladesh

Like in many lower-middle-income countries (LMIC), progress in implementing evidence-based practices (EBPs) for children with autism spectrum disorder (ASD) has been slow in Bangladesh. This cross-sectional study examined professionals' attitudes towards evidence-based practice (EBP) for children and adolescents with ASD and explored how providers' demographic factors are related to attitudes to and adoption of EBPs in Bangladesh. The sample consisted of 150 mental health professionals and special teachers from the urban area of Dhaka. Attitudes were assessed by the Evidence-based Practice Attitude Scale-36. Findings indicated that professionals have favorable attitudes towards EBP. Their attitudes varied depending on service settings (public clinical, private clinical, and special school) and caseload per year. Professionals who work in private and special school settings claimed to be more willing to adopt an EBP when required and perceived a higher fit of EBPs and their work than those in public clinical settings. The number of different EBPs used also differed by service setting. Every type of intervention (except medication) was used by more professionals in special schools than in private and public clinical settings. Many professionals reported few barriers to the implementation of EBPs. These findings indicate conditions that are often conducive to the implementation of EBPs. However, these results do not reflect the situation in rural areas, in which poverty is more widespread and the number of specialized professionals is low.

Strengthening the quality of clinical trials of acupuncture: a guideline protocol

INTRODUCTION

Acupuncture has been accepted in many Western countries and clinical trials have been increasing recently. However, the problems of insufficient and low-quality evidence remain, and substantially hinder the development of acupuncture clinical trials. We therefore aim to develop a guideline to strengthen the quality of acupuncture clinical trials, in accordance with WHO handbook for guideline development and the Reporting Items for practice Guidelines in HealThcare. The guideline will help to improve the quality of acupuncture clinical trials.

METHODS AND ANALYSIS

We will search for studies on the quality of acupuncture clinical trials using PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang Data, China Science and Technology Journal Database, The Cochrane Library, the WHO and Health Technology Assessment websites, and other sources. We will also check reference lists and contact experts in the field. We will systematically evaluate the quality of acupuncture clinical trials, and extract and summarise the quality problems and countermeasures of such trials. We will also systematically review clinical trial quality control manuals and systems and formulate research questions on quality control in acupuncture clinical trials. Finally, we will develop the guideline and establish a comprehensive quality control system to ensure high quality acupuncture clinical trials. We will also evaluate the guideline and will update the guideline to reflect new scientific evidence.

ETHICS AND DISSEMINATION

Ethics committee approval and informed consent are not required for developing guideline because only published data will be used, however, we will interview the patients, the ethics committee approval has been got from West China Hospital of Sichuan Unversity (Number: 2021-1188). We will publish all manuscripts arising from this research and present the findings at conferences.

GUIDELINE REGISTRATION NUMBER

IPGRP-2021CN093.

Comparing Fidelity Outcomes of Paraprofessional and Professional Delivery of a Perinatal Depression Preventive Intervention

Mothers and Babies (MB), a perinatal depression preventive intervention, has proven effective in decreasing depressive symptoms and preventing onset of major depression. An ongoing cluster-randomized trial is comparing the effectiveness of the six-session MB group intervention led by paraprofessionals versus mental health professionals. Twenty percent of all audio-recorded intervention sessions were randomly selected for fidelity checks. Analyses assessed mean facilitator adherence and competency overall, by study arm, and by session; and, examined site, facilitator, and client-specific effects. There were no significant differences found between study arms. Findings show paraprofessionals can deliver MB with similar fidelity as mental health professionals.

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?

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.

Adapting parent engagement strategies for an evidence-based parent-mediated intervention for young children at risk for autism spectrum disorder

AIMS

Aims included (a) characterizing provider feedback on parent engagement strategies integrated into a parent-mediated intervention for toddlers at risk for autism spectrum disorder (ASD) and (b) identifying provider characteristics that predict attitudes about parent engagement strategies.

METHODS

A mixed method approach was utilized, including gathering quantitative data via survey (breadth) and collecting qualitative data via interview (depth). Acceptability, utility, appropriateness, sustainment, generalizability, and perceived effectiveness were examined. Fourteen agency leaders and 24 therapists provided input.

RESULTS

Providers perceived the integration of parent engagement strategies as having a positive impact on implementation. Providers considered the strategies to be acceptable, appropriate, and effective, though barriers of time and complexity were noted. Provider characteristics did not consistently predict attitudes about the engagement strategies.

CONCLUSIONS

Incorporating parent engagement strategies into parent-mediated interventions for ASD is well-received by providers and may improve quality of service delivery for families served in early intervention for ASD.

How Intervention and Implementation Characteristics Relate to Community Therapists' Attitudes Toward Evidence-Based Practices: A Mixed Methods Study

Therapists' perceptions toward evidence-based practices (EBPs) are important in implementation efforts, however little is known about characteristics of EBPs associated with more positive attitudes. This mixed-methods study examined how intervention and implementation characteristics of six EBPs related to therapist attitudes. Quantitative analysis of 793 cross-sectional surveys revealed that therapists endorsed more positive attitudes toward EBPs with (1) prescribed session content and order and (2) required consultation. Associations between these intervention and implementation characteristics and attitudes were not moderated by therapist experience or emotional exhaustion. Qualitative analyses complemented quantitative findings, indicating that "structure" was appealing for interventions and that therapists felt supported by consultation.

Establishing a library of resources to help people understand key concepts in assessing treatment claims-The "Critical thinking and Appraisal Resource Library" (CARL)

BACKGROUND

People are frequently confronted with untrustworthy claims about the effects of treatments. Uncritical acceptance of these claims can lead to poor, and sometimes dangerous, treatment decisions, and wasted time and money. Resources to help people learn to think critically about treatment claims are scarce, and they are widely scattered. Furthermore, very few learning-resources have been assessed to see if they improve knowledge and behavior.

OBJECTIVES

Our objectives were to develop the Critical thinking and Appraisal Resource Library (CARL). This library was to be in the form of a database containing learning resources for those who are responsible for encouraging critical thinking about treatment claims, and was to be made available online. We wished to include resources for groups we identified as 'intermediaries' of knowledge, i.e. teachers of schoolchildren, undergraduates and graduates, for example those teaching evidence-based medicine, or those communicating treatment claims to the public. In selecting resources, we wished to draw particular attention to those resources that had been formally evaluated, for example, by the creators of the resource or independent research groups.

METHODS

CARL was populated with learning-resources identified from a variety of sources-two previously developed but unmaintained inventories; systematic reviews of learning-interventions; online and database searches; and recommendations by members of the project group and its advisors. The learning-resources in CARL were organised by 'Key Concepts' needed to judge the trustworthiness of treatment claims, and were made available online by the James Lind Initiative in Testing Treatments interactive (TTi) English (www.testingtreatments.org/category/learning-resources).TTi English also incorporated the database of Key Concepts and the Claim Evaluation Tools developed through the Informed Healthcare Choices (IHC) project (informedhealthchoices.org).

RESULTS

We have created a database of resources called CARL, which currently contains over 500 open-access learning-resources in a variety of formats: text, audio, video, webpages, cartoons, and lesson materials. These are aimed primarily at 'Intermediaries', that is, 'teachers', 'communicators', 'advisors', 'researchers', as well as for independent 'learners'. The resources included in CARL are currently accessible at www.testingtreatments.org/category/learning-resources.

CONCLUSIONS

We hope that ready access to CARL will help to promote the critical thinking about treatment claims, needed to help improve healthcare choices.