Casting a wider net in behavioral health screening in primary care: a preliminary study of the Outcome Rating Scale

The "3 Es" of trauma-informed care in a federally qualified health center: Traumatic Event- and Experience-related predictors of physical and mental health Effects among female patients

Federally Qualified Health Centers (FQHCs) are a fast-growing source of healthcare for women with intersectional identities, or those most frequently exposed to and negatively impacted by interpersonal trauma. According to the "3 E" conceptualization of trauma, certain Event- and Experience-related characteristics of a trauma predict victims' physical and mental health Effects. The "3 Es" have yet to be studied in female FQHC patients. The current study examined the prevalence of interpersonal trauma and interrelationships among traumatic Event-related factors (e.g., cumulative trauma by victim-perpetrator relationship), Experience-related factors (e.g., betrayal, resilience), and Effects (e.g., somatic symptoms, posttraumatic stress (PTS), anxiety/depression, mistrust, reduced sense of safety) among 138 predominantly Black (89.1%) women receiving care at an FQHC in the southeastern U.S. Roughly 65% of participants (n = 86) endorsed exposure to at least one type of interpersonal trauma. More cumulative trauma was significantly correlated with more somatic, PTS, and anxious/depressive symptoms, and a reduced sense of safety. Experiences of betrayal and/or resilience were better predictors of PTS and anxious/depressive symptoms and lack of safety than Event-related factors. Findings support the need for the implementation of trauma-informed care within community-based health centers. Healthcare providers should consider women's subjective experience of trauma when screening for exposure and providing trauma-sensitive care.

Development of the MIND: a Screening Measure Assessing Mental Health Treatment Needs

Early identification and treatment of mental illness symptoms results in better outcomes, yet few screeners are available that can be efficiently used in community settings. The Mental Illness Needs Detection (MIND) Screener was developed to identify the need for mental health treatment and administered to 820 adults across the USA. Confirmatory factor analysis supported the internal consistency of the MIND. The MIND significantly correlated with the Kessler-10 (K10; a well-validated screener), reported mental illness, mental health treatment, and the need for treatment. The MIND's ability to accurately assess treatment needs was further demonstrated through high sensitivity (84%; 83%), specificity (71%; 62%), and AUC values (0.77; 0.73) when compared to both the K10 and reported need for treatment, respectively. These findings support the validity and reliability of the MIND and indicate its promise as a means of detecting a wide range of mental health needs across a variety of settings.

Construct Validity of Outcome Rating Scale (ORS) Scores in Clinical Samples: Extension of Harris, Murphy, and Rakes' (2019) Narrative Review

PURPOSE

A recent review of 24 studies primarily evaluated psychometric properties of the Outcome Rating Scale (ORS) related to coefficient alpha and convergent validity.

METHOD

To provide a fuller picture, this review examined effect size (ES) estimates and the full range of correlations between ORS scores and related measures.

RESULTS

Mean ORS ESs equaled 1.00 for 44 comparison periods. ORS scores correlated highest with measures of depression and evidenced larger ESs in depression treatments.

DISCUSSION

The ORS functions as a robust measure for detecting client progress in clinical samples that were primarily young, female, and Caucasian. Some results suggest ORS scores primarily reflect a rapid response to interventions.

CONCLUSION AND LIMITATIONS

Future research should assess ORS scores' psychometric properties in response to interventions with more heterogeneous client samples as well as its capacity to monitor change beyond initial sessions.

The Psychometric Properties of the Session Rating Scale: A Narrative Review

Background: The Session Rating Scale (SRS) is a measure used in psychotherapy practice. Given its application and frequent use in clinical practice settings, several studies including primary validation studies as well as outcome studies reporting psychometric properties have examined the validity and reliability of the SRS. Because the SRS is designed to be used in clinical practice, demonstration of reliability and validity is ideal with clinical populations instead of non-clinical populations. To our knowledge, there have been no reviews evaluating the psychometric properties of the SRS with clinical populations.Purpose: The aim of this study was to review and synthesize the psychometric properties of the SRS by examining all relevant outcome and validation studies.Methods: We completed an electronic literature search of several online databases in order to identify relevant articles. We identified 12 articles that met our inclusion and analyzed the reliability and validity evidence for the SRS with clinical populations.Results: Findings showed high internal consistency for the SRS and support evidence that the underlying dimension is a measure of therapeutic alliance. Test-retest reliability estimates were reported in 4 of the 12 studies included in this review (ranging from .54 to .70). The SRS had low to moderate concurrent validity with other longer measures of therapeutic alliance (.29 with ORS; .48 with HAQ II; .57-.65 with WAI).Discussion: Clinicians should be aware of the limitations in validity evidence for the SRS that may result from its brevity. However, clinicians should also consider the relative stability of the SRS as a pragmatic global measure of the construct of therapeutic alliance. Future research efforts should focus on validation of the SRS with larger, more diverse samples and specific clinical populations with a wider range of symptom severity.

Collaborative Care for Depression of Adults and Adolescents: Measuring the Effectiveness of Screening and Treatment Uptake

OBJECTIVE

This study analyzed effectiveness of screening, referrals, and treatment uptake of a collaborative care for depression intervention across 10 primary care clinics in Chicago.

METHODS

Between November 2016 and December 2017, patients (N=25,369) were screened with the Patient Health Questionnaire-2 and the Patient Health Questionnaire-9 on the basis of an eligibility algorithm. Electronic health record data were analyzed for sample characteristics, screening rates, referrals, and treatment pathways. To identify disparities, a test of proportions was conducted between eligible and screened patients as well as referred and treated patients.

RESULTS

Screenings, referrals, and uptake occurred proportionately across subgroups except for patients ages 12-17. Adolescent age was associated with disproportionate Patient Health Questionnaire-9 screenings and with treatment disengagement.

CONCLUSIONS

The intervention shows promise in expanding access to care and reducing disparities. Greater access to psychotherapies and innovative treatment modalities, particularly for adolescents, may improve overall treatment uptake.

Psychometric Properties of the Outcome Rating Scale (ORS) in a Spanish Clinical Sample

The Outcome Rating Scale (ORS) is an ultra-brief measure of well-being designed to track outcome in psychotherapy. This research studied the psychometric properties of the ORS in a Spanish clinical sample. One-hundred and sixty-five adult participants from different primary care centers of the city of Barcelona were recruited. The psychometric properties of the ORS in the sample were explored and described, comparing them to the properties of other instruments already validated in Spain. Our results showed good reliability (α = .91 [.88, .93]; α = .96; test re-test correlations from .61 to .84), good validity (convergent validity correlations with distress and symptoms measures from -.32 to -.76), and good sensitivity to change (pre-post comparison through Wilcoxon signed-rank test, Mdnpre = 31.0, Mdnpost = 19.6, z = -7.38, p < .05, r = .42). These results are consistent with previous findings in other countries. We conclude suggesting that the instrument can be applied to monitor outcome in psychotherapy and to test the effectiveness of treatments imparted with Spanish speaking clients. However, further research with the ORS in Spanish could provide more evidence of its psychometric properties.