The challenge of ensuring affordability, sustainability, consistency, and adaptability in the common metrics agenda

A mixed-methods evaluation of a longitudinal primary-secondary school transitions support intervention

Introduction

Primary-secondary school transitions are critical transitions for children that can be emotionally demanding longitudinal experiences, which can positively and negatively impact future emotional wellbeing and mental health. However, interventions that have been developed to reduce the negative outcomes children commonly experience are limited in number, sustainability, and reach and rely on a cross-sectional approach, as opposed to longitudinal evaluations. The current study evaluates Transitions 5-7, a universal, class-based 9-week intervention to develop children's awareness and ability to cope with the multiple changes experienced over primary-secondary school transitions.

Methods

The evaluation utilized a mixed-methods approach, combining both quantitative outcome and qualitative process intervention evaluation. For the outcome evaluation, a quasi-experimental research design was used, and children of the intervention and comparison groups completed a questionnaire in Year 5 (n = 185), Year 6 (n = 217), and Year 7 (n = 162), which assessed their self-reported perception of Transitions Worries, Transitions Excitement, Emotional Wellbeing, Parental Support, and Coping Efficacy. To understand the implementation of Transitions 5-7, three focus groups were conducted with Year 6 children, 3 interviews with teachers, and 1 interview with the Transitions Manager of the local government education authority during the project, who developed Transitions 5-7.

Results

The outcome evaluation found that children participating in the intervention showed a decrease in Transitions Worries and an increase in Transitions Excitement and Coping Efficacy compared with the comparison group, resulting in a lowered impact on Emotional Wellbeing over time. The need for a more systemic approach to primary-secondary school support provision, which is gradual, has a distinct delivery and follows a skills-based curriculum, was discussed in the process evaluation. Meta-inferences drawn demonstrate the importance of gradual emotional centered transitions provision embedded within Years 5, 6, and 7.

Discussion

The present study makes a unique empirical contribution in demonstrating the need and viability to take a preventative as opposed to a curative approach to primary-secondary school transitions support provision and begin early in Year 5. Conceptual and methodological implications for future research and implications for educational policy and practice are discussed.

Mental Health and Well-being Measures for Mean Comparison and Screening in Adolescents: An Assessment of Unidimensionality and Sex and Age Measurement Invariance

Adolescence is a period of increased vulnerability for low well-being and mental health problems, particularly for girls and older adolescents. Accurate measurement via brief self-report is therefore vital to understanding prevalence, group trends, screening efforts, and response to intervention. We drew on data from the #BeeWell study (N = 37,149, aged 12-15) to consider whether sum-scoring, mean comparisons, and deployment for screening were likely to show bias for eight such measures. Evidence for unidimensionality, considering dynamic fit confirmatory factor models, exploratory graph analysis, and bifactor modeling, was found for five measures. Of these five, most showed a degree of non-invariance across sex and age likely incompatible with mean comparison. Effects on selection were minimal, except sensitivity was substantially lower in boys for the internalizing symptoms measure. Measure-specific insights are discussed, as are general issues highlighted by our analysis, such as item reversals and measurement invariance.

A Collaborative Effort to Establish Common Metrics for Use in Mental Health

This Viewpoint provides a summary of a new project launched by a coalition of research funders and journals to improve the measures used in mental health research.

Measuring the active elements of cognitive-behavioral therapies

Understanding how and for whom cognitive-behavioral therapies work is central to the development and improvement of mental health interventions. Suboptimal quantification of the active elements of cognitive-behavioral therapies has hampered progress in elucidating mechanisms of change. To advance process research on cognitive-behavioral therapies, we describe a theoretical measurement framework that focuses on the delivery, receipt, and application of the active elements of these interventions. We then provide recommendations for measuring the active elements of cognitive-behavioral therapies aligned with this framework. Finally, to support measurement harmonization and improve study comparability, we propose the development of a publicly available repository of assessment tools: the Active Elements of Cognitive-Behavioral Therapies Measurement Kit.

Common measures in mental health: a joint initiative by funders and journals

There is notable heterogeneity in how clinical and phenotypic data are measured by mental health researchers. There is a proliferation of self-report measures (eg, over 280 for depression alone), meaning it is challenging for researchers to compare findings across different studies from different laboratories. To begin to address this issue, a consortium of mental health research funders and journals has launched the Common Measures in Mental Health Science Initiative. The purpose of this endeavour is to identify common measures for mental health conditions that funders and journals can require all researchers to collect, in addition to any other measures they require for their specific study. These measures would not necessarily capture the full range of experiences of a given condition but could be used to link and compare across studies with different designs in different contexts. This Health Policy outlines the rationale, objectives, and potential challenges of this initiative, which aims to enhance the rigour and comparability of mental health research by promoting the adoption of standardised measures.

A computational approach to measure the linguistic characteristics of psychotherapy timing, responsiveness, and consistency

Although individual psychotherapy is generally effective for a range of mental health conditions, little is known about the moment-to-moment language use of effective therapists. Increased access to computational power, coupled with a rise in computer-mediated communication (telehealth), makes feasible the large-scale analyses of language use during psychotherapy. Transparent methodological approaches are lacking, however. Here we present novel methods to increase the efficiency of efforts to examine language use in psychotherapy. We evaluate three important aspects of therapist language use - timing, responsiveness, and consistency - across five clinically relevant language domains: pronouns, time orientation, emotional polarity, therapist tactics, and paralinguistic style. We find therapist language is dynamic within sessions, responds to patient language, and relates to patient symptom diagnosis but not symptom severity. Our results demonstrate that analyzing therapist language at scale is feasible and may help answer longstanding questions about specific behaviors of effective therapists.

Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration

Psychiatry has always been characterized by a range of different models of and approaches to mental disorder, which have sometimes brought progress in clinical practice, but have often also been accompanied by critique from within and without the field. Psychiatric nosology has been a particular focus of debate in recent decades; successive editions of the DSM and ICD have strongly influenced both psychiatric practice and research, but have also led to assertions that psychiatry is in crisis, and to advocacy for entirely new paradigms for diagnosis and assessment. When thinking about etiology, many researchers currently refer to a biopsychosocial model, but this approach has received significant critique, being considered by some observers overly eclectic and vague. Despite the development of a range of evidence-based pharmacotherapies and psychotherapies, current evidence points to both a treatment gap and a research-practice gap in mental health. In this paper, after considering current clinical practice, we discuss some proposed novel perspectives that have recently achieved particular prominence and may significantly impact psychiatric practice and research in the future: clinical neuroscience and personalized pharmacotherapy; novel statistical approaches to psychiatric nosology, assessment and research; deinstitutionalization and community mental health care; the scale-up of evidence-based psychotherapy; digital phenotyping and digital therapies; and global mental health and task-sharing approaches. We consider the extent to which proposed transitions from current practices to novel approaches reflect hype or hope. Our review indicates that each of the novel perspectives contributes important insights that allow hope for the future, but also that each provides only a partial view, and that any promise of a paradigm shift for the field is not well grounded. We conclude that there have been crucial advances in psychiatric diagnosis and treatment in recent decades; that, despite this important progress, there is considerable need for further improvements in assessment and intervention; and that such improvements will likely not be achieved by any specific paradigm shifts in psychiatric practice and research, but rather by incremental progress and iterative integration.

Readability of Commonly Used Quality of Life Outcome Measures for Youth Self-Report

Self-report measures are central in capturing young people’s perspectives on mental health concerns and treatment outcomes. For children and adolescents to complete such measures meaningfully and independently, the reading difficulty must match their reading ability. Prior research suggests a frequent mismatch for mental health symptom measures. Similar analyses are lacking for measures of Quality of Life (QoL). We analysed the readability of 13 commonly used QoL self-report measures for children and adolescents aged 6 to 18 years by computing five readability formulas and a mean reading age across formulas. Across measures, the mean reading age for item sets was 10.7 years (SD = 1.2). For almost two-thirds of the questionnaires, the required reading age exceeded the minimum age of the target group by at least one year, with an average discrepancy of 3.0 years (SD = 1.2). Questionnaires with matching reading ages primarily targeted adolescents. Our study suggests a frequent mismatch between the reading difficulty of QoL self-report measures for pre-adolescent children and this group’s expected reading ability. Such discrepancies risk undermining the validity of measurement, especially where children also have learning or attention difficulties. Readability should be critically considered in measure development, as one aspect of the content validity of self-report measures for youth.