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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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Bruns EJ, Lee K, Davis C, Pullmann MD, Ludwig K, Sander M, Holm-Hansen C, Hoover S, McCauley EM. Effectiveness of a Brief Engagement, Problem-Solving, and Triage Strategy for High School Students: Results of a Randomized Study. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:701-714. [PMID: 36930402 DOI: 10.1007/s11121-022-01463-4] [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: 10/20/2022] [Indexed: 03/18/2023]
Abstract
Schools offer an advantageous setting for the prevention, early identification, and treatment of mental health problems for youth. However, school mental health (SMH) services are typically not based on evidence for effectiveness, nor are they efficiently delivered, with SMH practitioners (SMHPs) able to only treat a small number of students in need. The current study evaluated the feasibility, acceptability, efficiency, and outcomes of a four-session assessment, engagement, problem-solving, and triage strategy for SMHPs that aimed to improve efficiency while being based on elements of evidence-based care. The study, conducted in 15 US school districts in three states, used stratified random assignment to assign 49 high schools and their participating SMHP(s) to either the Brief Intervention for School Clinicians (BRISC; N = 259 students) or services as usual (SAU; N = 198 students). SMHPs implemented BRISC elements with adequate to excellent fidelity and reported the strategy was feasible and well-aligned with presenting problems. Students assigned to BRISC reported significantly greater engagement in SMH at 2 months and completion of SMH treatment by 6 months. BRISC-assigned SMHPs reported significantly greater treatment completion after four sessions (53.4%) compared to SAU (15.4%). Students in the BRISC condition also reported significantly greater reduction in problem severity as evaluated by the Youth Top Problems Assessment. No differences were found for anxiety or depression symptoms or overall functioning. Results indicate that BRISC is a feasible early intervention and triage strategy that may aid in more efficient provision of SMH services with no compromise to SMH effectiveness.
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Affiliation(s)
- Eric J Bruns
- University of Washington School of Medicine, Seattle, USA.
| | - Kristine Lee
- University of Washington School of Medicine, Seattle, USA
| | - Chayna Davis
- University of Washington School of Medicine, Seattle, USA
| | | | - Kristy Ludwig
- University of Washington School of Medicine, Seattle, USA
| | - Mark Sander
- Midwest Center for School Mental Health, St. Paul, USA
| | | | - Sharon Hoover
- University of Maryland School of Medicine, Baltimore, USA
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Connors EH, Lyon AR, Garcia K, Sichel CE, Hoover S, Weist MD, Tebes JK. Implementation strategies to promote measurement-based care in schools: evidence from mental health experts across the USA. Implement Sci Commun 2022; 3:67. [PMID: 35729657 PMCID: PMC9210728 DOI: 10.1186/s43058-022-00319-w] [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] [Received: 02/09/2022] [Accepted: 06/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite an established taxonomy of implementation strategies, minimal guidance exists for how to select and tailor strategies to specific practices and contexts. We employed a replicable method to obtain stakeholder perceptions of the most feasible and important implementation strategies to increase mental health providers' use of measurement-based care (MBC) in schools. MBC is the routine use of patient-reported progress measures throughout treatment to inform patient-centered, data-driven treatment adjustments. METHODS A national sample of 52 school mental health providers and researchers completed two rounds of modified Delphi surveys to rate the relevance, importance, and feasibility of 33 implementation strategies identified for school settings. Strategies were reduced and definitions refined using a multimethod approach. Final importance and feasibility ratings were plotted on "go-zone" graphs and compared across providers and researchers to identify top-rated strategies. RESULTS The initial 33 strategies were rated as "relevant" or "relevant with changes" to MBC in schools. Importance and feasibility ratings were high overall for both survey rounds; on a scale of 1 to 5, importance ratings (3.61-4.48) were higher than feasibility ratings (2.55-4.06) on average. Survey 1 responses resulted in a reduced, refined set of 21 strategies, and six were rated most important and feasible on Survey 2: (1) assess for readiness and identify barriers and facilitators; (2) identify and prepare champions; (3) develop a usable implementation plan; (4) offer a provider-informed menu of free, brief measures; (5) develop and provide access to training materials; and (6) make implementation easier by removing burdensome documentation tasks. Provider and researcher ratings were not significantly different, with a few exceptions: providers reported higher feasibility and importance of removing burdensome paperwork than researchers, providers reported higher feasibility of train-the trainer approaches than researchers, and researchers reported higher importance of monitoring fidelity than providers. CONCLUSIONS The education sector is the most common setting for child and adolescent mental health service delivery in the USA. Effective MBC implementation in schools has the potential to elevate the quality of care received by many children, adolescents, and their families. This empirically derived, targeted list of six implementation strategies offers potential efficiencies for future testing of MBC implementation in schools.
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Affiliation(s)
- Elizabeth H. Connors
- grid.47100.320000000419368710Department of Psychiatry, Yale University, 389 Whitney Avenue, Office 106, New Haven, CT 06511 USA
| | - Aaron R. Lyon
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Kaylyn Garcia
- grid.47100.320000000419368710Department of Psychiatry, Yale University, 389 Whitney Avenue, Office 106, New Haven, CT 06511 USA
- grid.254567.70000 0000 9075 106XDepartment of Psychology, University of South Carolina, 1512 Pendelton Street, Columbia, SC 29208 USA
| | - Corianna E. Sichel
- grid.47100.320000000419368710Department of Psychiatry, Yale University, 389 Whitney Avenue, Office 106, New Haven, CT 06511 USA
- grid.21729.3f0000000419368729Division of Child/Adolescent Psychiatry, Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032 USA
| | - Sharon Hoover
- grid.411024.20000 0001 2175 4264Department of Psychiatry, University of Maryland, 737 West Lombard Street, 4th Floor, Baltimore, MD 21201 USA
| | - Mark D. Weist
- grid.254567.70000 0000 9075 106XDepartment of Psychology, University of South Carolina, 1512 Pendelton Street, Columbia, SC 29208 USA
| | - Jacob K. Tebes
- grid.47100.320000000419368710Department of Psychiatry, Yale University, 389 Whitney Avenue, Office 106, New Haven, CT 06511 USA
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Lui JHL, Brookman-Frazee L, Smith A, Lind T, Terrones L, Rodriguez A, Motamedi M, Villodas M, Lau AS. Implementation facilitation strategies to promote routine progress monitoring among community therapists. Psychol Serv 2022; 19:343-352. [PMID: 33793283 PMCID: PMC8484366 DOI: 10.1037/ser0000456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Despite substantial support for the importance of routine progress monitoring (RPM) as part of evidence-based practice, few providers utilize measurement-based care. This study sought to identify the relative importance of facilitation strategies viewed as most helpful for increasing intention to use RPM among 388 ethnically diverse community therapists serving children and families. Four types of facilitation strategies were examined: language/interpretability, automation, staffing/access, and requirements. Mixed analyses of variance found that therapists' reported intentions to use RPM were more influenced by strategies of automating assessment administration, provision of clerical assistance, and agency requirements than by making linguistically appropriate measures available. However, the importance of strategies differed depending on therapist race/ethnicity and current RPM use. Language/interpretability of RPM assessments was less emphasized for non-Hispanic White therapists and therapists who have not yet or only minimally adopted RPM compared with ethnic minority therapists and therapists who regularly use RPM, respectively. Furthermore, therapists who were not current RPM users emphasized automation more than staffing/access. Results may inform prioritization of implementation facilitation strategies for agencies to encourage RPM. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | - Ashley Smith
- Department of Psychology, University of California
| | - Teresa Lind
- Department of Psychiatry, University of California
| | | | | | | | | | - Anna S Lau
- Department of Psychology, University of California
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5
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Trajectories of Symptom Change in School-Based Prevention Programs for Adolescent Girls with Subclinical Depression. J Youth Adolesc 2022; 51:659-672. [PMID: 35113294 PMCID: PMC8924105 DOI: 10.1007/s10964-022-01578-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/19/2022] [Indexed: 11/21/2022]
Abstract
Effectiveness research on depression prevention usually compares pre- to post-intervention outcomes across groups, but this aggregation across individuals may mask heterogeneity in symptom change trajectories. Hence, this study aimed to identify subgroups of adolescents with unique trajectories of change in a school-based depression prevention trial. It was also examined how trajectory membership was associated with the intervention conditions, depressive symptoms at 12-month follow-up, and baseline predictors. Hundred-ninety adolescent girls (Mage = 13.34; range = 11–16 years) with subclinical depression at screening (M = 57 days before pre-test) were allocated to four conditions: a face-to-face, group-based program (OVK), a computerized, individual program (SPARX), OVK and SPARX combined, and a monitoring control condition. Growth Mixture Modeling was used to identify the distinct trajectories during the intervention period using weekly depressive symptom assessments from pre-test to post-test. Analyses revealed three trajectories of change in the full sample: Moderate-Declining (62.1% of the sample), High-Persistent (31.1%), and Deteriorating-Declining (6.8%) trajectories. Trajectories were unrelated to the intervention conditions and the High-Persistent trajectory had worse outcomes at follow-up. Several baseline factors (depression severity, age, acceptance, rumination, catastrophizing, and self-efficacy) enabled discrimination between trajectories. It is concluded that information about likely trajectory membership may enable (school) clinicians to predict an individual’s intervention response and timely adjust and tailor intervention strategies as needed.
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Deaton JD, Ohrt JH, Linich K, Wymer B, Toomey M, Lewis O, Guest JD, Newton T. Teachers' experiences with K‐12 students' mental health. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jennifer D. Deaton
- Counseling and Educational Development Department University of North Carolina at Greensboro Greensboro North Carolina USA
| | | | - Kathryn Linich
- University of South Carolina Columbia South Carolina USA
| | | | | | - Olivia Lewis
- University of South Carolina Columbia South Carolina USA
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7
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Patel ZS, Jensen-Doss A, Lewis CC. MFA and ASA-MF: A Psychometric Analysis of Attitudes Towards Measurement-Based Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:13-28. [PMID: 33942200 DOI: 10.1007/s10488-021-01138-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/30/2022]
Abstract
Measurement based care (MBC) improves client outcomes by providing clinicians with routine mental health outcome data that can be used to inform treatment planning but is rarely used in practice. The Monitoring and Feedback Attitudes Scale (MFA) and Attitudes Towards Standardized Assessment Scales-Monitoring and Feedback (ASA-MF) (Jensen-Doss et al., 2016) may identify attitudinal barriers to MBC, which could help trainings and implementation strategies. This study examines the psychometric properties of the MFA and ASA-MF, including the factor structure, longitudinal invariance, and indicators of validity, in a sample of community mental health clinicians (N = 164). The measures demonstrate adequate fit to their factor structures across time and predict MBC use as captured in a client's electronic health record. Given that clinician attitudes are associated with MBC use, using instruments with psychometric support to assess attitudes fills a research to practice gap.
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Affiliation(s)
- Zabin S Patel
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA.
| | - Amanda Jensen-Doss
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
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Connors E, Lawson G, Wheatley-Rowe D, Hoover S. Exploration, Preparation, and Implementation of Standardized Assessment in a Multi-agency School Behavioral Health Network. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:464-481. [PMID: 32940885 PMCID: PMC7965785 DOI: 10.1007/s10488-020-01082-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
School mental health treatment services offer broad public health impact and could benefit from more widespread implementation and sustainment of standardized assessments (SA). This demonstration study describes one approach to increase SA use in a large school behavioral health network using the Exploration, Preparation, Implementation and Sustainment (EPIS) framework. Mental health administrator interviews with four participating agencies and a multidisciplinary planning team informed SA measure selection and implementation supports. The SA initiative was implemented during one school year, including system-wide training and ongoing implementation supports for 95 clinicians. Linear mixed effect models revealed improvements in clinician attitudes about the SA for clinical utility and treatment planning immediately following the half-day training (N = 95, p < .001). Clinicians self-reported a significant increase in use of SA for new clients during intakes (p < .001) over time and 71.4% of expected SA data were submitted. Qualitative feedback, including recommendations to offer more SA choices and beginning new SA data collection earlier in the school year, was integrated to inform quality improvements and future sustainment efforts.
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Affiliation(s)
- Elizabeth Connors
- Department of Psychiatry, Yale University, 389 Whitney Avenue, Office 106, New Haven, CT, 06511, USA.
| | - Gwendolyn Lawson
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 8th Floor, Philadelphia, PA, 19146, USA
| | - Denise Wheatley-Rowe
- Behavioral Health System Baltimore, 100 South Charles Street, Tower 2, 8th Floor, Baltimore, MD, 20201, USA
| | - Sharon Hoover
- Division of Child and Adolescent Psychiatry, National Center for School Mental Health, University of Maryland School of Medicine, 737 West Lombard Street, 4th Floor, Baltimore, MD, 21201, USA
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9
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Use of Standardized and Non-Standardized Tools for Measuring the Risk of Falls and Independence in Clinical Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063226. [PMID: 33804715 PMCID: PMC8004039 DOI: 10.3390/ijerph18063226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 01/20/2023]
Abstract
(1) Background: The use of standardized tools is regarded as the basis for an evidence-based assessment. The tools enable monitoring of complex events and the effectiveness of adopted interventions. Some healthcare facilities use standardized tools such as the Morse Fall Scale, but many use non-standardized tools created based on patient needs. Our study question was, why are non-standardized tools used when standardized tools are more beneficial and can be statistically evaluated and compared to other results; (2) Methods: We used a quantitative, non-standardized questionnaire to survey 1200 nurses, which was representative sample for the entire Czech Republic. All questionnaires were assessed in two phases (a) the frequency evaluation and descriptive analysis, and (b) hypotheses testing and correlation analyses; (3) Results: We found that the Conley Scale, Barthel test, and IADL test were preferred by many nurses. Furthermore, we found that nurses using standardized assessment scales noticed risk factors significantly more frequently but regarded the increased complexity of care to be psychologically demanding. (4) Conclusions: In patients with physical disabilities, both types of tools (internal non-standardized and standardized) are used to assess the risk of falls and independence; nurses generally welcomed the increase use of standardized tools in their facilities.
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10
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Connors EH, Douglas S, Jensen-Doss A, Landes SJ, Lewis CC, McLeod BD, Stanick C, Lyon AR. What Gets Measured Gets Done: How Mental Health Agencies can Leverage Measurement-Based Care for Better Patient Care, Clinician Supports, and Organizational Goals. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:250-265. [PMID: 32656631 DOI: 10.1007/s10488-020-01063-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Mental health clinicians and administrators are increasingly asked to collect and report treatment outcome data despite numerous challenges to select and use instruments in routine practice. Measurement-based care (MBC) is an evidence-based practice for improving patient care. We propose that data collected from MBC processes with patients can be strategically leveraged by agencies to also support clinicians and respond to accountability requirements. MBC data elements are outlined using the Precision Mental Health Framework (Bickman et al. in Adm Policy Mental Health Mental Health Serv Res 43:271-276, 2016), practical guidance is provided for agency administrators, and conceptual examples illustrate strategic applications of one or more instruments to meet various needs throughout the organization.
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Affiliation(s)
- Elizabeth H Connors
- Department of Psychiatry, Yale University, 389 Whitney Avenue, Office 106, New Haven, CT, 06511, USA.
| | - Susan Douglas
- Department of Leadership, Policy and Organizations, Vanderbilt University, 230 Appleton Place, Nashville, TN, 37203, USA
| | - Amanda Jensen-Doss
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - Sara J Landes
- VISN 16 Mental Illness Research, Education, and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, 72114, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101-1466, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Bryce D McLeod
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin Street, PO Box 842018, Richmond, VA, 23284, USA
| | - Cameo Stanick
- Clinical Practice, Training, and Research and Evaluation, Hathaway-Sycamores Child and Family Services, 100 W. Walnut Street, Ste #375, Pasadena, CA, 91124, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
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11
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Ohrt JH, Deaton JD, Linich K, Guest JD, Wymer B, Sandonato B. Teacher training in K–12 student mental health: A systematic review. PSYCHOLOGY IN THE SCHOOLS 2020. [DOI: 10.1002/pits.22356] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jonathan H. Ohrt
- Department of Educational StudiesUniversity of South Carolina Columbia South Carolina
| | - Jennifer D. Deaton
- Department of Educational StudiesUniversity of South Carolina Columbia South Carolina
| | - Kathryn Linich
- Department of Educational StudiesUniversity of South Carolina Columbia South Carolina
| | - Jessie D. Guest
- Department of Educational StudiesUniversity of South Carolina Columbia South Carolina
| | - Brooke Wymer
- Department of Education and Human DevelopmentClemson University Clemson South Carolina
| | - Brittany Sandonato
- Counseling Department, Gilbert Elementary SchoolLexington One School District Lexington South Carolina
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12
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Lyon AR, Whitaker K, Richardson LP, French WP, McCauley E. Collaborative Care to Improve Access and Quality in School-Based Behavioral Health. THE JOURNAL OF SCHOOL HEALTH 2019; 89:1013-1023. [PMID: 31612501 DOI: 10.1111/josh.12843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/27/2018] [Accepted: 08/12/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND Collaborative care (CC) is a well-established approach for the delivery of accessible behavioral health services in integrated health care settings. Substantial evidence supports its effectiveness in improving the quality and outcomes of adult services, and growing research indicates utility with child and adolescent populations. METHODS To date, studies examining CC models for youth have focused exclusively on primary-care settings. Nevertheless, as the most common integrated service delivery setting for youth, the education sector is an equally important context for improving access to behavioral health services for children and adolescents. RESULTS We provide a narrative review of the literature on CC, describes the relevance of CC to schools, and details its alignment with contemporary movements in education and school-based behavioral health. CONCLUSIONS Potential adaptations of the CC model for use in schools are detailed to improve: (1) behavioral health service accessibility, (2) the capacity of schools to provide behavioral health services, and (3) school service effectiveness through use of evidence-based practices. Although little research has explored the applicability of CC in the education sector, the model holds potential promise to improve the quality and efficiency of school-based behavioral health services.
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Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115
| | - Kelly Whitaker
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115
| | - Laura P Richardson
- University of Washington/Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, M/S CW8-6, Seattle, WA, 98121
| | - William P French
- University of Washington, 4800 Sand Point Way NE, M/S OA.5.154, PO Box 5371, Seattle, WA, 98145
| | - Elizabeth McCauley
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115
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13
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Jensen-Doss A, Smith AM, Becker-Haimes EM, Mora Ringle V, Walsh LM, Nanda M, Walsh SL, Maxwell CA, Lyon AR. Individualized Progress Measures Are More Acceptable to Clinicians Than Standardized Measures: Results of a National Survey. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:392-403. [PMID: 29143173 DOI: 10.1007/s10488-017-0833-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite research supporting measurement-based care grounded in standardized progress measures, such measures are underutilized by clinicians. Individualized measures of client-specific targets present an alternative, but little is known about their acceptability or use. We compared attitudes toward and use of standardized and individualized progress measures in a national sample of 504 clinicians. Clinicians reported neutral to positive attitudes toward both types of measures, but strongly preferred and were more likely to use individualized measures. Clinician attitudes, theoretical orientation, and work setting predicted assessment preferences and practices. Implications for dissemination and implementation of measurement-based care are discussed.
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Affiliation(s)
- Amanda Jensen-Doss
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA.
| | - Ashley M Smith
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA.,University of California, Los Angeles, USA
| | | | - Vanesa Mora Ringle
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | - Lucia M Walsh
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | - Monica Nanda
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | | | - Colleen A Maxwell
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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14
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Rodriguez A, Terrones L, Brookman-Frazee L, Regan J, Smith A, Lau AS. Associations between cultural identity and attitudes toward routine progress monitoring in a sample of ethnically diverse community therapists. Psychol Serv 2019; 17:282-290. [PMID: 30714751 DOI: 10.1037/ser0000327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Community mental health services are increasingly embracing evidence-based interventions (EBIs), and the professional workforce is diversifying to meet the needs of historically underserved groups. As such, it is increasingly important to understand how psychotherapist cultural factors may be associated with attitudes toward EBIs. The use of standardized assessments within routine progress monitoring is a cornerstone of EBIs, yet therapist attitudes remain an obstacle to implementation. The current study examines the associations between therapist cultural identity and attitudes toward and use of routine progress monitoring. An online survey was used to gather data from 229 ethnic minority community therapists delivering EBIs in a large public mental health system serving children and families. Therapists had an average age of 35.2 years (SD = 7.7), 86.5% were female, 69.9% were Hispanic/Latinx and 30.2% were other ethnic minority, 36.2% were licensed, 90.8% held a master's degree, and 76.4% reported ability to deliver services in a non-English language. Hierarchical multiple regression analyses revealed that stronger heritage cultural identity was related to perceptions of potential harm with routine progress monitoring. In addition, more favorable views of standardized assessment instructions were associated with positive attitudes toward routine progress monitoring. We discuss how findings point to the need for additional user-centered research with diverse community therapists to learn how assessment and progress monitoring can be better designed to address their cultural and racial-based concerns. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Lewis CC, Boyd M, Puspitasari A, Navarro E, Howard J, Kassab H, Hoffman M, Scott K, Lyon A, Douglas S, Simon G, Kroenke K. Implementing Measurement-Based Care in Behavioral Health: A Review. JAMA Psychiatry 2018; 76:324-335. [PMID: 30566197 PMCID: PMC6584602 DOI: 10.1001/jamapsychiatry.2018.3329] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Measurement-based care (MBC) is the systematic evaluation of patient symptoms before or during an encounter to inform behavioral health treatment. Despite MBC's demonstrated ability to enhance usual care by expediting improvements and rapidly detecting patients whose health would otherwise deteriorate, it is underused, with typically less than 20% of behavioral health practitioners integrating it into their practice. This narrative review addresses definitional issues, offers a concrete and evaluable operationalization of MBC fidelity, and summarizes the evidence base and utility of MBC. It also synthesizes the extant literature's characterization of barriers to and strategies for supporting MBC implementation, sustainment, and scale-up. OBSERVATIONS Barriers to implementing MBC occur at multiple levels: patient (eg, concerns about confidentiality breach), practitioner (eg, beliefs that measures are no better than clinical judgment), organization (eg, no resources for training), and system (eg, competing requirements). Implementation science-the study of methods to integrate evidence-based practices such as MBC into routine care-offers strategies to address barriers. These strategies include using measurement feedback systems, leveraging local champions, forming learning collaboratives, training leadership, improving expert consultation with clinical staff, and generating incentives. CONCLUSIONS AND RELEVANCE This narrative review, informed by implementation science, offers a 10-point research agenda to improve the integration of MBC into clinical practice: (1) harmonize terminology and specify MBC's core components; (2) develop criterion standard methods for monitoring fidelity and reporting quality of implementation; (3) develop algorithms for MBC to guide psychotherapy; (4) test putative mechanisms of change, particularly for psychotherapy; (5) develop brief and psychometrically strong measures for use in combination; (6) assess the critical timing of administration needed to optimize patient outcomes; (7) streamline measurement feedback systems to include only key ingredients and enhance electronic health record interoperability; (8) identify discrete strategies to support implementation; (9) make evidence-based policy decisions; and (10) align reimbursement structures.
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Affiliation(s)
- Cara C. Lewis
- Kaiser Permanente Washington Health Research Institute,
Seattle
| | - Meredith Boyd
- Department of Psychology, UCLA (University of California, Los
Angeles)
| | - Ajeng Puspitasari
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester,
Minnesota
| | - Elena Navarro
- Kaiser Permanente Washington Health Research Institute,
Seattle
| | - Jacqueline Howard
- Department of Psychological and Brain Sciences, Indiana University,
Bloomington
| | | | - Mira Hoffman
- Department of Psychology, West Virginia University,
Morgantown
| | - Kelli Scott
- School of Public Health, Brown University, Providence, Rhode
Island
| | - Aaron Lyon
- Department of Psychiatry and Behavioral Sciences, University of
Washington, Seattle
| | - Susan Douglas
- Department of Leadership, Policy and Organizations, Peabody
College, Vanderbilt University, Nashville, Tennessee
| | - Greg Simon
- Kaiser Permanente Washington Health Research Institute,
Seattle
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Lyon AR, Stanick C, Pullmann MD. Toward high‐fidelity treatment as usual: Evidence‐based intervention structures to improve usual care psychotherapy. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bergman H, Kornør H, Nikolakopoulou A, Hanssen‐Bauer K, Soares‐Weiser K, Tollefsen TK, Bjørndal A. Client feedback in psychological therapy for children and adolescents with mental health problems. Cochrane Database Syst Rev 2018; 8:CD011729. [PMID: 30124233 PMCID: PMC6513116 DOI: 10.1002/14651858.cd011729.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Childhood and adolescent mental health problems are a serious and growing concern worldwide. Research suggests that psychotherapy can have a significant and positive impact on children and adolescents with mental health problems, such as anxiety disorders, depression and conduct disorders. Client feedback tools serve as a method of monitoring clients' progress and providing feedback from clients to therapists during the therapeutic process. These tools may help to enhance clinicians' decision-making by allowing them to adapt their treatment plans as the therapy progresses, resulting in a reduction of treatment failures. Research has shown that client feedback tools have a positive effect on adults' psychotherapy. This review addresses whether feedback tools in child and adolescent therapy could help therapists to better treat their young clients. OBJECTIVES To assess the effects of client feedback in psychological therapy on child and adolescent mental health outcomes. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR, Studies and References), the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (1946-), Embase (1974-) and PsycINFO (1967-) to 3 April 2018. We did not apply any restriction on date, language or publication status to the search. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared client feedback to no client feedback in psychological therapies for children and adolescents. DATA COLLECTION AND ANALYSIS Two review authors independently assessed references for inclusion eligibility and extracted outcome, risk of bias and study characteristics data into customised forms. We contacted study authors to obtain missing data. We analysed dichotomous data using risk ratios (RRs) and calculated their 95% confidence intervals (CIs). For continuous data, we calculated mean differences (MDs), or standardised mean differences (SMDs) if different scales were used to measure the same outcome. We used a random-effects model for all analyses. MAIN RESULTS We included six published RCTs, conducted in the USA (5 RCTs) and Israel (1 RCT), with 1097 children and adolescents (11 to 18 years old), in the review.We are very uncertain about the effect of client feedback on improvement of symptoms, as reported by youth in the short term because we considered evidence to be of very low-certainty due to high risk of bias and very serious inconsistency in the effect estimates from the different studies. Similarly, we are very uncertain about the effect of client feedback on treatment acceptability, due to high risk of bias, imprecision in the results, and indirectness of measuring the outcome (RR 1.08, 95% CI 0.73 to 1.61; 2 studies, 237 participants; very low-certainty).Overall, most studies reported and carried out randomisation and allocation concealment adequately. None of the studies were blinded or attempted to blind participants and personnel and were at high risk of performance bias, and only one study had blind outcome assessors. All of the studies were at high or unclear risk of attrition bias mainly due to poor, non-transparent reporting of participants' flow through the studies. AUTHORS' CONCLUSIONS Due to the paucity of high-quality data and considerable inconsistency in results from different studies, there is currently insufficient evidence to reach any firm conclusions regarding the role of client feedback in psychological therapies for children and adolescents with mental health problems, and further research on this important topic is needed.Future studies should avoid risks of performance, detection and attrition biases, as seen in the studies included in this review. Studies from countries other than the USA are needed, as well as studies including children younger than 10 years.
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Affiliation(s)
- Hanna Bergman
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Hege Kornør
- Norwegian Institute of Public HealthDivision of Health ServicesPO box 222 Skøyen0213 OsloNorway
| | | | - Ketil Hanssen‐Bauer
- Akershus University HospitalDivision of Mental Health ServicesLørenskogNorway
| | - Karla Soares‐Weiser
- CochraneEditorial & Methods DepartmentSt Albans House, 57 ‐ 59 HaymarketLondonUKSW1Y 4QX
| | - Thomas K Tollefsen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP)RBUP, Postboks 4623NydalenOsloNorway0405
| | - Arild Bjørndal
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP)RBUP, Postboks 4623NydalenOsloNorway0405
- University of OsloFaculty of MedicineOsloNorway
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Lyon AR, Pullmann MD, Dorsey S, Martin P, Grigore AA, Becker EM, Jensen-Doss A. Reliability, Validity, and Factor Structure of the Current Assessment Practice Evaluation-Revised (CAPER) in a National Sample. J Behav Health Serv Res 2018; 46:43-63. [DOI: 10.1007/s11414-018-9621-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Jensen-Doss A, Haimes EMB, Smith AM, Lyon AR, Lewis CC, Stanick CF, Hawley KM. Monitoring Treatment Progress and Providing Feedback is Viewed Favorably but Rarely Used in Practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:48-61. [PMID: 27631610 PMCID: PMC5495625 DOI: 10.1007/s10488-016-0763-0] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Numerous trials demonstrate that monitoring client progress and using feedback for clinical decision-making enhances treatment outcomes, but available data suggest these practices are rare in clinical settings and no psychometrically validated measures exist for assessing attitudinal barriers to these practices. This national survey of 504 clinicians collected data on attitudes toward and use of monitoring and feedback. Two new measures were developed and subjected to factor analysis: The monitoring and feedback attitudes scale (MFA), measuring general attitudes toward monitoring and feedback, and the attitudes toward standardized assessment scales-monitoring and feedback (ASA-MF), measuring attitudes toward standardized progress tools. Both measures showed good fit to their final factor solutions, with excellent internal consistency for all subscales. Scores on the MFA subscales (Benefit, Harm) indicated that clinicians hold generally positive attitudes toward monitoring and feedback, but scores on the ASA-MF subscales (Clinical Utility, Treatment Planning, Practicality) were relatively neutral. Providers with cognitive-behavioral theoretical orientations held more positive attitudes. Only 13.9 % of clinicians reported using standardized progress measures at least monthly and 61.5 % never used them. Providers with more positive attitudes reported higher use, providing initial support for the predictive validity of the ASA-MF and MFA. Thus, while clinicians report generally positive attitudes toward monitoring and feedback, routine collection of standardized progress measures remains uncommon. Implications for the dissemination and implementation of monitoring and feedback systems are discussed.
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Affiliation(s)
- Amanda Jensen-Doss
- Child Division, Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA.
| | - Emily M Becker Haimes
- Child Division, Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | - Ashley M Smith
- Child Division, Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | | | - Cara C Lewis
- University of Washington, Seattle, USA
- Indiana University, Bloomington, USA
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Steinfeld B, Franklin A, Mercer B, Fraynt R, Simon G. Progress Monitoring in an Integrated Health Care System: Tracking Behavioral Health Vital Signs. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 43:369-78. [PMID: 25840521 DOI: 10.1007/s10488-015-0648-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Progress monitoring implementation in an integrated health care system is a complex process that must address factors such as measurement, technology, delivery system care processes, patient needs and provider requirements. This article will describe how one organization faced these challenges by identifying the key decision points (choice of measure, process for completing rating scale, interface with electronic medical record and clinician engagement) critical to implementation. Qualitative and quantitative data will be presented describing customer and stakeholder satisfaction with the mental health progress monitoring tool (MHPMT) as well as organizational performance with key measurement targets.
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Affiliation(s)
- Bradley Steinfeld
- Group Health Cooperative, 950 Pacific Ave Suite 900, Tacoma, WA, 98402, USA.
| | | | - Brian Mercer
- Group Health Cooperative, 950 Pacific Ave Suite 900, Tacoma, WA, 98402, USA
| | - Rebecca Fraynt
- Group Health Cooperative, 950 Pacific Ave Suite 900, Tacoma, WA, 98402, USA
| | - Greg Simon
- Group Health Research Institute, Seattle, USA
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21
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Determinants and Functions of Standardized Assessment Use Among School Mental Health Clinicians: A Mixed Methods Evaluation. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 43:122-34. [PMID: 25875325 DOI: 10.1007/s10488-015-0626-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The current study evaluated why and how school mental health clinicians use standardized assessment tools in their work with youth and families. Quantitative and qualitative (focus group) data were collected prior to and following a training and consultation sequence as part of a trial program to assess school clinician's (n = 15) experiences administering standardized tools to youth on their caseloads (n = 191). Findings indicated that, although assessment use was initially somewhat low, clinicians used measures to conduct initial assessments with the bulk of their caseloads (average = 62.2%) during the implementation period. Clinicians also reported on factors influencing their use of assessments at the client, provider, and system levels; perceived functions of assessment; student responses to assessment use; and use of additional sources of clinically-relevant information (primarily educational data) for the purposes of assessment and progress monitoring. Implications for the contextual appropriateness of standardized assessment and training in assessment tools are discussed.
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22
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Advancing Evidence-Based Assessment in School Mental Health: Key Priorities for an Applied Research Agenda. Clin Child Fam Psychol Rev 2016; 19:271-284. [PMID: 27730441 DOI: 10.1007/s10567-016-0217-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Nadeem E, Cappella E, Holland S, Coccaro C, Crisonino G. Development and Piloting of a Classroom-Focused Measurement Feedback System. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 43:379-93. [PMID: 25894312 PMCID: PMC4609583 DOI: 10.1007/s10488-015-0651-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The present study used a community partnered research method to develop and pilot a classroom-focused measurement feedback system (MFS) for school mental health providers to support teachers' use of effective universal and target classroom practices related to student emotional and behavioral issues. School personnel from seven urban elementary and middle school classrooms participated. Phase I involved development and refinement of the system through a baseline needs assessment and rapid-cycle feedback. Phase II involved detailed case study analysis of pre-to-post quantitative and implementation process data. Results suggest that teachers who used the dashboard along with consultation showed improvement in observed classroom organization and emotional support. Results also suggest that MFS use was tied closely to consultation dose, and that broader support at the school level was critical. Classroom-focused MFSs are a promising tool to support classroom improvement, and warrant future research focused on their effectiveness and broad applicability.
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Affiliation(s)
- Erum Nadeem
- Department of Child and Adolescent Psychiatry, New York University, One Park Ave, 7th Floor, NYU Child Study Center, New York, NY, 10016, USA.
| | - Elise Cappella
- Department of Applied Psychology, Steinhardt School of New York University, New York, NY, USA
| | - Sibyl Holland
- Graduate School of Education, Harvard University, Cambridge, MA, USA
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Lyon AR, Wasse JK, Ludwig K, Zachry M, Bruns EJ, Unützer J, McCauley E. The Contextualized Technology Adaptation Process (CTAP): Optimizing Health Information Technology to Improve Mental Health Systems. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 43:394-409. [PMID: 25677251 PMCID: PMC4536193 DOI: 10.1007/s10488-015-0637-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Health information technologies have become a central fixture in the mental healthcare landscape, but few frameworks exist to guide their adaptation to novel settings. This paper introduces the contextualized technology adaptation process (CTAP) and presents data collected during Phase 1 of its application to measurement feedback system development in school mental health. The CTAP is built on models of human-centered design and implementation science and incorporates repeated mixed methods assessments to guide the design of technologies to ensure high compatibility with a destination setting. CTAP phases include: (1) Contextual evaluation, (2) Evaluation of the unadapted technology, (3) Trialing and evaluation of the adapted technology, (4) Refinement and larger-scale implementation, and (5) Sustainment through ongoing evaluation and system revision. Qualitative findings from school-based practitioner focus groups are presented, which provided information for CTAP Phase 1, contextual evaluation, surrounding education sector clinicians' workflows, types of technologies currently available, and influences on technology use. Discussion focuses on how findings will inform subsequent CTAP phases, as well as their implications for future technology adaptation across content domains and service sectors.
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Affiliation(s)
- Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St., Suite 100, Seattle, WA, 98115, USA.
| | | | - Kristy Ludwig
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St., Suite 100, Seattle, WA, 98115, USA
| | - Mark Zachry
- Department of Human Centered Design and Engineering, University of Washington, Seattle, USA
| | - Eric J Bruns
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St., Suite 100, Seattle, WA, 98115, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St., Suite 100, Seattle, WA, 98115, USA
| | - Elizabeth McCauley
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St., Suite 100, Seattle, WA, 98115, USA
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Ng MY, Weisz JR. Annual Research Review: Building a science of personalized intervention for youth mental health. J Child Psychol Psychiatry 2016; 57:216-36. [PMID: 26467325 PMCID: PMC4760855 DOI: 10.1111/jcpp.12470] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Within the past decade, health care service and research priorities have shifted from evidence-based medicine to personalized medicine. In mental health care, a similar shift to personalized intervention may boost the effectiveness and clinical utility of empirically supported therapies (ESTs). The emerging science of personalized intervention will need to encompass evidence-based methods for determining which problems to target and in which order, selecting treatments and deciding whether and how to combine them, and informing ongoing clinical decision-making through monitoring of treatment response throughout episodes of care. We review efforts to develop these methods, drawing primarily from psychotherapy research with youths. Then we propose strategies for building a science of personalized intervention in youth mental health. FINDINGS The growing evidence base for personalizing interventions includes research on therapies adapted for specific subgroups; treatments targeting youths' environments; modular therapies; sequential, multiple assignment, randomized trials; measurement feedback systems; meta-analyses comparing treatments for specific patient characteristics; data-mining decision trees; and individualized metrics. CONCLUSION The science of personalized intervention presents questions that can be addressed in several ways. First, to evaluate and organize personalized interventions, we propose modifying the system used to evaluate and organize ESTs. Second, to help personalizing research keep pace with practice needs, we propose exploiting existing randomized trial data to inform personalizing approaches, prioritizing the personalizing approaches likely to have the greatest impact, conducting more idiographic research, and studying tailoring strategies in usual care. Third, to encourage clinicians' use of personalized intervention research to inform their practice, we propose expanding outlets for research summaries and case studies, developing heuristic frameworks that incorporate personalizing approaches into practice, and integrating personalizing approaches into service delivery systems. Finally, to build a richer understanding of how and why treatments work for particular individuals, we propose accelerating research to identify mediators within and across RCTs, to isolate mechanisms of change, and to inform the shift from diagnoses to psychopathological processes. This ambitious agenda for personalized intervention science, although challenging, could markedly alter the nature of mental health care and the benefit provided to youths and families.
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Affiliation(s)
- Mei Yi Ng
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
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Duong MT, Lyon AR, Ludwig K, Wasse JK, McCauley E. Student Perceptions of the Acceptability and Utility of Standardized and Idiographic Assessment in School Mental Health. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2016; 18:19-63. [PMID: 27441029 DOI: 10.1080/14623730.2015.1079429] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Evidence-based assessment (EBA) comprises the use of research and theory to select methods and processes that have demonstrated reliability, validity, and clinical usefulness for prescribed populations. EBA can lead to positive clinical change, and recent work has suggested that it is perceived to be useful by school mental health providers. However, virtually nothing is known about student perceptions of assessment use. Semi-structured interviews were conducted with 31 ethnically diverse middle and high school students (71% female) receiving mental health services in school-based health centers. Findings indicated that the majority of students found assessments to be useful, and perceived three primary functions of assessments: structuring the therapy session, increasing students' self-awareness, and improving communication with the provider. Barriers to acceptability were also found for a minority of respondents. Some students found the nature of standardized assessments to be confining, and others expressed that they wanted more feedback from their counselors about their responses. Idiographic assessments demonstrated especially high acceptability in this sample, with students reporting that tracking idiographic outcomes increased self-awareness, spurred problem-solving, and helped them to reach behavioral goals. Implications for school mental health service improvements are discussed.
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Affiliation(s)
- Mylien T Duong
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Kristy Ludwig
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | | | - Elizabeth McCauley
- Department of Psychiatry and Behavioral Sciences, University of Washington
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The Brief Intervention for School Clinicians (BRISC): A mixed-methods evaluation of feasibility, acceptability, and contextual appropriateness. SCHOOL MENTAL HEALTH 2015; 7:273-286. [PMID: 26688700 DOI: 10.1007/s12310-015-9153-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To maximize impact across the broad spectrum of mental health needs exhibited by youth in school settings, interventions must be designed to be effective, efficient, and demonstrate good fit with the educational context. The current paper reports on the second phase of an iterative development process for a short-term, "Tier 2" intervention for use by school-based mental health providers - the Brief Intervention for School Clinicians (BRISC) - using mixed qualitative and quantitative analyses to evaluate feasibility, acceptability, and appropriateness while emphasizing student experiences. This phase was intended to yield information to drive further protocol refinement and testing across subsequent phases. We describe the rationale for, development of, and formative testing of the BRISC intervention. Results suggest that BRISC may be feasible to deliver, acceptable to students, and appropriate to the school context. In particular, the BRISC process appears to be effective in enhancing student engagement in the intervention and identifying and addressing individualized student needs. These findings and directions for further enhancing BRISC's potential for positive impact highlight how treatment development may benefit from initial, small-scale evaluations focused both on client and implementation outcomes.
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Moore LA, Aarons GA, Davis JH, Novins DK. How do providers serving American Indians and Alaska Natives with substance abuse problems define evidence-based treatment? Psychol Serv 2015; 12:92-100. [PMID: 25961645 PMCID: PMC4430337 DOI: 10.1037/ser0000022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Rates of substance abuse remain high in American Indian and Alaska Native (AI/AN) populations. While there are many evidence-based treatments (EBTs) for substance use problems, no studies exist describing how directors of treatment programs serving AI/ANs perceive and use EBTs. Twenty-one key informant interviews with program administrators and 10 focus groups with clinicians were conducted at 18 treatment programs for AI/ANs with substance use problems. Demographic data were not collected to protect participant privacy. Transcripts were coded to identify relevant themes. A majority of participants correctly defined an EBT using the key terms "effective" and "research" found in standard definitions of the phrase. More detailed descriptions were uncommon. Prevalent themes related to attitudes about EBTs included concerns about cultural relevance, external mandates to use EBTs, and their reliance on western conceptualization of substance abuse. While most administrators and clinicians who treat AI/AN clients for substance abuse had a basic understanding of what constitutes an EBT, there was little consensus regarding their relevance for use with AI/ANs. Recognizing that broad geographic and tribal diversity among AI/AN populations may impact conclusions drawn about EBTs, several factors may enhance the abilities of program staff to identify EBTs most appropriate for local implementation. These include gaining a more detailed understanding of how an EBT is developed and how to assess its scientific grounding, as well as utilizing definitions of EBTs that include not only research evidence, but also clinical expertise and judgment, and fit with consumer choice, preference, and culture.
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Affiliation(s)
- Laurie A Moore
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus
| | | | | | - Douglas K Novins
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus
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Jensen-Doss A. Practical, Evidence-Based Clinical Decision Making: Introduction to the Special Series. COGNITIVE AND BEHAVIORAL PRACTICE 2015. [DOI: 10.1016/j.cbpra.2014.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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30
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Translating Evidence-Based Assessment Principles and Components Into Clinical Practice Settings. COGNITIVE AND BEHAVIORAL PRACTICE 2015. [DOI: 10.1016/j.cbpra.2014.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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