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Last BS, Kiefer M, Mirhashem R, Adams DR. Slipping Through the Cracks: Clinicians' Perspectives on the Gaps in New York City's Public Mental Health System. Community Ment Health J 2024:10.1007/s10597-024-01333-z. [PMID: 39141222 DOI: 10.1007/s10597-024-01333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/19/2024] [Indexed: 08/15/2024]
Abstract
Most people who seek mental health treatment cannot access it. Certain groups (e.g., Medicaid enrollees and the uninsured) face particularly severe treatment access barriers along the care continuum. We interviewed 31 clinicians across two studies about their perspectives working in New York City's public mental health system. Because every clinician across both studies reported gaps in the system, we deployed an emergent, "serendipitous finding" approach and qualitatively analyzed the interviews together. Clinicians described three public mental health system gaps. First, many treatment-seekers must wait long periods of time to receive care and some never receive it at all. Second, patients with more serious challenges cannot access longer-term, higher-intensity, or specialized treatment. Third, some patients receiving high-intensity services may benefit from lower-intensity mental health support that is better integrated with medical and social service support. Coordinated and sustained financial investments at every step of the mental healthcare continuum are needed.
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Affiliation(s)
- Briana S Last
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
| | - Madeline Kiefer
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Rebecca Mirhashem
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Danielle R Adams
- Brown School of Social Work and Public Health, Washington University in St. Louis, St. Louis, MO, USA
- School of Social Work, University of Missouri, Columbia, MO, USA
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Ghose SS, George P, Goldman HH, Daley TC, Dixon LB, Ren W, Zhu X, Rosenblatt A. State Mental Health Authority Level of Involvement in Coordinated Specialty Care Clinics and Client Outcomes. Psychiatr Serv 2023; 74:250-256. [PMID: 36128698 DOI: 10.1176/appi.ps.202100676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE State mental health authorities (SMHAs) in all U.S. states and territories administer the Mental Health Block Grant (MHBG) set-aside funding for first-episode psychosis. Funds support implementation of coordinated specialty care (CSC) programs. The authors investigated the relationship between the level of SMHA involvement with CSC programs and clinical outcomes of clients in these programs. METHODS As part of a mixed-methods study of 34 CSC programs, SMHAs from 21 states and one U.S. territory associated with the 34 CSC programs participated in a 1-hour interview (between November 2018 and May 2019) focused on SMHA involvement in administration of MHBG set-aside funds and the SMHA's ongoing relationship with funded CSC programs. SMHA involvement was rated on a scale of 1 to 5, with 5 indicating the highest involvement. Client outcome data were collected at the 34 study sites over an 18-month period. Multilevel random-effect modeling was used, controlling for response propensity (propensity score), client demographic variables, and program-level covariates (i.e., fidelity score, staff turnover rates, service area urbanicity, and number of clients enrolled). RESULTS Clients in CSC programs with SMHAs that were the most involved (level 5) had significantly improved symptoms, social functioning, and role functioning, compared with clients in programs with which SMHAs were least involved (level 1). CONCLUSIONS The findings suggest that increased SMHA involvement in CSC programs is relevant for positive client outcomes. Levels of first-episode psychosis funding doubled in 2021 and 2022, and it is important to identify how SMHAs affect the success of CSC programs and the individuals served.
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Affiliation(s)
- Sushmita Shoma Ghose
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon)
| | - Preethy George
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon)
| | - Howard H Goldman
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon)
| | - Tamara Cohen Daley
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon)
| | - Lisa B Dixon
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon)
| | - Weijia Ren
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon)
| | - Xiaoshu Zhu
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon)
| | - Abram Rosenblatt
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon)
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Bickman L. Improving Mental Health Services: A 50-Year Journey from Randomized Experiments to Artificial Intelligence and Precision Mental Health. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:795-843. [PMID: 32715427 PMCID: PMC7382706 DOI: 10.1007/s10488-020-01065-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This conceptual paper describes the current state of mental health services, identifies critical problems, and suggests how to solve them. I focus on the potential contributions of artificial intelligence and precision mental health to improving mental health services. Toward that end, I draw upon my own research, which has changed over the last half century, to highlight the need to transform the way we conduct mental health services research. I identify exemplars from the emerging literature on artificial intelligence and precision approaches to treatment in which there is an attempt to personalize or fit the treatment to the client in order to produce more effective interventions.
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Affiliation(s)
- Leonard Bickman
- Center for Children and Families; Psychology, Academic Health Center 1, Florida International University, 11200 Southwest 8th Street, Room 140, Miami, FL, 33199, USA.
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Herman KC, Reinke WM, Thompson AM, M. Hawley K, Wallis K, Stormont M, Peters C. A Public Health Approach to Reducing the Societal Prevalence and Burden of Youth Mental Health Problems: Introduction to the Special Issue. SCHOOL PSYCHOLOGY REVIEW 2021. [DOI: 10.1080/2372966x.2020.1827682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Keith C. Herman
- Missouri Prevention Science Institute, University of Missouri
| | - Wendy M. Reinke
- Missouri Prevention Science Institute, University of Missouri
| | | | | | - Kelly Wallis
- Missouri Prevention Science Institute, University of Missouri
| | | | - Clark Peters
- Missouri Prevention Science Institute, University of Missouri
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Traveling Without a Map: An Incomplete History of the Road to Implementation Science and Where We May Go from Here. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:272-278. [PMID: 31938973 DOI: 10.1007/s10488-020-01013-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This editorial provides a brief history of mental health services research over the last 30 years and how findings from large-scale studies shocked the field and led to the lines of inquiry culminating in current implementation science research. I review the manuscripts published in this special issue of Administration and Policy in Mental Health in light of that history and usethese studies as a way to assess the state of the field. Finally, I present five takeaways extracted from these articles that may be useful in considering future directions for implementation research.
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Vander Stoep A, McCarty CA, Zhou C, Rockhill CM, Schoenfelder EN, Myers K. The Children's Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: Caregiver Outcomes. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 45:27-43. [PMID: 27117555 DOI: 10.1007/s10802-016-0155-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The Children's Attention-deficit Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS) tested the hypotheses that children and caregivers who received guideline-based treatment delivered through a hybrid telehealth service delivery model would experience greater improvements in outcomes than children and caregivers receiving treatment via a comparison delivery model. Here, we present caregiver outcomes. 88 primary care providers (PCPs) in seven geographically underserved communities referred 223 children (ages 5.5 - 12.9 years) to the randomized controlled trial. Over 22 weeks, children randomized to the CATTS service delivery model received six sessions of telepsychiatry and six sessions of caregiver behavior management training provided in person by community therapists who were trained and supervised remotely. Children randomized to the comparison Augmented Primary Care (APC) service model received management in primary care augmented by a single telepsychiatry consultation. Caregiver outcomes included changes in distress, as measured by the Patient Health Questionnaire (PHQ-9), Parenting Stress Index (PSI), Caregiver Strain Questionnaire (CSQ) and Family Empowerment Scale (FES). Caregivers completed five assessments. Multilevel mixed effects regression modeling tested for differences between the two service delivery models in caregiver outcomes from baseline to 25 weeks. Compared to caregivers of children in the APC model, caregivers of children in the CATTS service model showed statistically significantly greater improvements on the PHQ-9 (β = -1.41, 95 % CI = [-2.74, -0.08], p < .05), PSI (β = -4.59, 95 % CI = [-7.87, - 1.31], p < .001), CSQ (β = -5.41, 95 % CI = [- 8.58, -2.24], p < .001) and FES (β = 6.69, 95 % CI = [2.32, 11.06], p < .01). Improvement in child ADHD symptoms mediated improved caregiver scores on the PSI and CSQ. Improvement in child ODD behaviors mediated caregiver CSQ scores. The CATTS trial supports the effectiveness of a hybrid telehealth service delivery model for reducing distress in caregivers of children with ADHD and suggests a mechanism through which the service model affected caregiver distress.
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Affiliation(s)
- Ann Vander Stoep
- Center for Child Health, Behavior, and Development, Seattle Childrens' Research Institute, 2001 Eighth Ave, Suite 400, Seattle, WA, 98121, USA. .,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, Seattle, WA, USA. .,Department of Epidemiology, University of Washington School of Public Health, Box 357236, Seattle, WA, 98195, USA.
| | - Carolyn A McCarty
- Center for Child Health, Behavior, and Development, Seattle Childrens' Research Institute, 2001 Eighth Ave, Suite 400, Seattle, WA, 98121, USA.,Department of Pediatrics, University of Washington School of Medicine, Box 356320, Seattle, WA, 98195, USA
| | - Chuan Zhou
- Center for Child Health, Behavior, and Development, Seattle Childrens' Research Institute, 2001 Eighth Ave, Suite 400, Seattle, WA, 98121, USA.,Department of Pediatrics, University of Washington School of Medicine, Box 356320, Seattle, WA, 98195, USA.,Department of Health Services, University of Washington School of Public Health, Box 357660, Seattle, WA, 98195, USA
| | - Carol M Rockhill
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, Seattle, WA, USA
| | - Erin N Schoenfelder
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, Seattle, WA, USA
| | - Kathleen Myers
- Center for Child Health, Behavior, and Development, Seattle Childrens' Research Institute, 2001 Eighth Ave, Suite 400, Seattle, WA, 98121, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, Seattle, WA, USA
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Palinkas LA, Garcia AR, Aarons GA, Finno-Velasquez M, Holloway IW, Mackie TI, Leslie LK, Chamberlain P. Measuring Use of Research Evidence: The Structured Interview for Evidence Use. RESEARCH ON SOCIAL WORK PRACTICE 2016; 26:550-564. [PMID: 27616869 PMCID: PMC5014436 DOI: 10.1177/1049731514560413] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVES This article describes the Standard Interview for Evidence Use (SIEU), a measure to assess the level of engagement in acquiring, evaluating, and applying research evidence in health and social service settings. METHOD Three scales measuring input, process, and output of research evidence and eight subscales were identified using principal axis factor analysis and parallel analysis of data collected from 202 state and county child welfare, mental health, and juvenile justice systems leaders. RESULTS The SIEU scales and subscales demonstrate strong internal consistency as well as convergent and discriminant validity. CONCLUSIONS The SIEU is easy to use and can be administered as a complete scale or as three smaller scales to separately examine evidence in acquisition, evaluation, or application. The measure demonstrates potential in understanding the role of research evidence in service settings and in monitoring the process of evidence-based practice and application of scientific principles in social work practice.
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Affiliation(s)
| | - Antonio R. Garcia
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | | | - Ian W. Holloway
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
| | - Thomas I. Mackie
- Institute for Clinical Research and Health Policy Studies, Tufts University Medical Center, Boston, MA, USA
| | - Laurel K. Leslie
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA
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Elkin TD, Sarver DE, Wong Sarver N, Young J, Buttross S. Future Directions for the Implementation and Dissemination of Statewide Developmental-Behavioral Pediatric Integrated Health Care. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:619-630. [PMID: 27210591 DOI: 10.1080/15374416.2016.1152551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The integration of mental health and pediatric health care services has long been a goal for both research and practice. With the advent of federal policies developed to mandate clinical efficiency across the health care spectrum, this issue is becoming more salient. Applied literature on this topic is only recently emerging, however, and there are limited contextual examples to guide program development, research, and refinement. This article presents background information relevant to the development of such a program (the Center for Advancement of Youth). The cultural and organizational contexts for the project are discussed, with particular emphasis on models for cooperation among several institutions of varying size and scope. The implications for the future of tangible research in this area are also discussed, with attention to extending lessons learned to diverse settings motivated to integrate various aspects of health care service provision.
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Affiliation(s)
- T David Elkin
- a Department of Psychiatry and Human Behavior , University of Mississippi Medical Center
| | - Dustin E Sarver
- b Department of Pediatrics , University of Mississippi Medical Center
| | - Nina Wong Sarver
- b Department of Pediatrics , University of Mississippi Medical Center
| | - John Young
- c Department of Psychology , University of Mississippi
| | - Susan Buttross
- b Department of Pediatrics , University of Mississippi Medical Center
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9
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Potter DA. Situated Motives of Lay Participants in Community Collaboratives for Children's Mental Health. QUALITATIVE HEALTH RESEARCH 2016; 26:426-437. [PMID: 25646002 DOI: 10.1177/1049732315570127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Publicly funded programs in many industrialized countries increasingly require the participation of citizens. In this article, I explore the "situated motives" of family members who participated alongside professionals in implementing children's mental health programs in two communities in the United States. I conducted in-depth interviews with family members and observed monthly meetings of Community Collaboratives to assess how family members understood their participation. The inductive data analysis demonstrates that family members participated (a) as a therapeutic outlet, (b) to pay it forward, (c) to gain new skills, (d) to have a voice, and/or (e) to empower the community. I then use Giddens' concepts of "life politics" and "emancipatory politics" to explore how these accounts variously reflected lay members' orientations as consumers, empowered individuals, and/or citizen advocates. In the absence of articulated and specific objectives for family participation, these "situated motives" were salient and had implications for how policy was implemented.
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Abstract
Assessment is an integral component of treatment. However, prior surveys indicate clinicians may not use standardized assessment strategies. We surveyed 1,510 clinicians and used multivariate analysis of variance to explore group differences in specific measure use. Clinicians used unstandardized measures more frequently than standardized measures, although psychologists used standardized measures more frequently than nonpsychologists. We also used latent profile analysis to classify clinicians based on their overall approach to assessment and examined associations between clinician-level variables and assessment class or profile membership. A four-profile model best fit the data. The largest profile consisted of clinicians who primarily used unstandardized assessments (76.7%), followed by broad-spectrum assessors who regularly use both standardized and unstandardized assessment (11.9%), and two smaller profiles of minimal (6.0%) and selective assessors (5.5%). Compared with broad-spectrum assessors, unstandardized and minimal assessors were less likely to report having adequate standardized measures training. Implications for clinical practice and training are discussed.
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Timimi S. Children and Young People's Improving Access to Psychological Therapies: inspiring innovation or more of the same? BJPsych Bull 2015; 39:57-60. [PMID: 26191433 PMCID: PMC4478906 DOI: 10.1192/pb.bp.114.047118] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/26/2014] [Accepted: 06/09/2014] [Indexed: 11/23/2022] Open
Abstract
In 2007 the UK Government announced a substantial expansion of funding for psychological therapies for those presenting with common mental health problems. This 'Improving Access to Psychological Therapies' (IAPT) project was widely welcomed, however, evidence backed, economic, and conceptual critiques were voiced from the start and the project remains controversial. In 2011, the UK government announced it was extending the IAPT project to encompass services for children and young people with the aim of 'transforming' the way mental health services are delivered to them. Here I critically reflect on the problems associated first with IAPT and then with CYP-IAPT and ponder whether CYP-IAPT is significantly different to the problematic adult IAPT project or more of the same.
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Chorpita BF, Daleiden EL. Doing more with what we know: introduction to the special issue. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2014; 43:143-4. [PMID: 24527945 DOI: 10.1080/15374416.2013.869751] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article introduces a special issue that provides an overarching conceptual model for advancing the impact of science on service delivery and includes some illustrations of these concepts in action from a variety of research teams in a diversity of contexts. Themes of the special issue include balancing considerations of efficacy, effectiveness, and extensiveness--for example, ensuring that treatments are not only reliable but also robust and widely relevant. It is argued that such a balance might be achieved through an increased focus on improving coordination of system resources (e.g., clients, providers, treatments, training programs) and through dynamic and developmental designs. The special issue is intended to raise the broader question of whether our current paradigms are satisfactory in moving us toward our shared vision, or whether we could do more with what we already know.
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Affiliation(s)
- Bruce F Chorpita
- a Department of Psychology , University of California , Los Angeles
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Bruns EJ, Walker JS, Bernstein A, Daleiden E, Pullmann MD, Chorpita BF. Family voice with informed choice: coordinating wraparound with research-based treatment for children and adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2013; 43:256-69. [PMID: 24325146 PMCID: PMC3954919 DOI: 10.1080/15374416.2013.859081] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The wraparound process is a type of individualized, team-based care coordination that has become central to many state and system efforts to reform children's mental health service delivery for youths with the most complex needs and their families. Although the emerging wraparound research base is generally positive regarding placements and costs, effect sizes are smaller for clinical and functional outcomes. This article presents a review of literature on care coordination and wraparound models, with a focus on theory and research that indicates the need to better connect wraparound-enrolled children and adolescents to evidence-based treatment (EBT). The article goes on to describe how recently developed applications of EBT that are based on quality improvement and flexible application of "common elements" of research-based care may provide a more individualized approach that better aligns with the philosophy and procedures of the wraparound process. Finally, this article presents preliminary studies that show the feasibility and potential effectiveness of coordinating wraparound with the Managing and Adapting Practice system, and discusses intervention development and research options that are currently under way.
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Affiliation(s)
- Eric J Bruns
- a Department of Psychiatry and Behavioral Sciences , University of Washington School of Medicine
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Vander Stoep A, Myers K. Methodology for conducting the children's attention-deficit hyperactivity disorder telemental health treatment study in multiple underserved communities. Clin Trials 2013; 10:949-58. [PMID: 23897950 DOI: 10.1177/1740774513494880] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Children living in nonmetropolitan communities are underserved by evidence-based mental health care and are underrepresented in clinical trials. PURPOSE In this article, we describe lessons learned in conducting the Children's Attention-Deficit Hyperactivity Disorder (ADHD) Telemental Health (TMH) Treatment Study (CATTS), a randomized controlled trial testing the effectiveness of TMH in improving outcomes of children with ADHD living in underserved communities. METHODS Children were referred by primary care providers (PCPs). The test intervention group received six telepsychiatry sessions with each session followed by an caregiver behavior training session delivered in-person by a local therapist. A secure website was used to support decision making by the telepsychiatrists and to facilitate real-time collaboration between the telepsychiatrists and community therapists. The control group received a single telepsychiatry consultation. Questionnaires tapping ADHD symptoms and other outcomes were administered to parents and teachers online through a secure portal from personal computers. RESULTS total of 88 PCPs in seven communities referred the 223 children who participated in the trial. Attrition in treatment sessions and research assessments was very low. Lessons learned TMH proved to be a viable means of providing evidence-based pharmacological services to children and training to local therapists. Recruitment was enhanced by offering the control group a telepsychiatry consultation. Site-specific strategies were needed to meet recruitment targets. CONCLUSIONS The CATTS trial used methods designed to optimize inclusion of children living in multiple dispersed and underserved areas. The study will serve as a model for other research projects aiming at reducing geographic disparities in access to quality mental health care.
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Affiliation(s)
- Ann Vander Stoep
- aDepartment of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
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Timimi S, Tetley D, Burgoine W, Walker G. Outcome Orientated Child and Adolescent Mental Health Services (OO-CAMHS): a whole service model. Clin Child Psychol Psychiatry 2013; 18:169-84. [PMID: 22548827 DOI: 10.1177/1359104512444118] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The international evidence base on factors that most influence outcomes in mental health care finds that matching therapeutic intervention to diagnosis has a clinically insignificant impact on outcomes. Decades of outcome research into treatment of psychiatric disorders shows that, despite the development of many new techniques, the outcomes being achieved in studies 30 years ago are similar to those being achieved now. In the last few years, new service models that incorporate systems of feedback on progress and alliance have emerged and show promise with regards improving overall outcomes for mental health service users. Growing familiarity with this outcome literature, together with a desire to be part of a service that can continue to improve patient outcomes, led a small community Child and Adolescent Mental Health Services team to develop a new whole service model - Outcome Orientated Child and Adolescent Mental Health Services (OO-CAMHS). OO-CAMHS incorporates key aspects of the evidence base on what could make a differential positive impact on outcomes and relinquishes those aspects that do not. In this paper, we outline the evidence base on which OO-CAMHS is built, describe the key features of the approach and present some of the early findings on its impact.
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Affiliation(s)
- Sami Timimi
- Faculty of Life, Health, and Social Sciences, University of Lincoln, UK.
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Abstract
Although the importance of healthy mental development in children and youth is not disputed, the mental health needs of far too many Canadian children are being ignored. Within the context of recent federal and provincial calls for systemic reform of the mental health care systems for children and youth, we underscore the necessity for ongoing innovation, development, education, and evaluation. This article describes our aims to establish demonstration and research sites focused on promising frameworks that draw from systems of care, public health, and resiliency approaches.
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Affiliation(s)
| | - Susan Rodger
- University of Western Ontario, London, ON, Canada
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Ringle JL, Huefner JC, James S, Pick R, Thompson RW. 12-month follow-up outcomes for youth departing and integrated residential continuum of care. CHILDREN AND YOUTH SERVICES REVIEW 2012; 34:10.1016/j.childyouth.2011.12.013. [PMID: 24273362 PMCID: PMC3835781 DOI: 10.1016/j.childyouth.2011.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study examined the 12-month post-departure outcomes for youth who exited a residential treatment program at differing levels of restrictiveness. Study participants were 120 youth who entered an integrated residential continuum of care at its most restrictive level and then either departed the program at the same level or stepped down and departed at a lower level of restrictiveness. Results indicate that youth who stepped down and exited at the lowest level of restrictiveness were the most likely to be living at home or in a homelike setting and experienced fewer formal post-departure out-of-home placements. However, there were no differences in post-departure rates of substance use, arrests, or being in school or having graduated. These results suggest that youth who were served in the integrated continuum and departed at the lowest level of restrictiveness had more positive outcomes at 12-month post-discharge.
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Affiliation(s)
- Jay L. Ringle
- Boys Town, 14100 Crawford Ave, Boys Town, NE 68010, United States
| | | | - Sigrid James
- Department of Social Work and Social Ecology, Loma Linda University, Loma Linda, CA 92350, United States
| | - Robert Pick
- Boys Town, 13603 Flanagan Blvd., Boys Town, NE 68010, United States
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Schwalbe CS, Gearing RE, MacKenzie MJ, Brewer KB, Ibrahim R. A meta-analysis of experimental studies of diversion programs for juvenile offenders. Clin Psychol Rev 2011; 32:26-33. [PMID: 22138452 DOI: 10.1016/j.cpr.2011.10.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 10/12/2011] [Accepted: 10/25/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Research to establish an evidence-base for the treatment of conduct problems and delinquency in adolescence is well established; however, an evidence-base for interventions with offenders who are diverted from the juvenile justice system has yet to be synthesized. The purpose of this study was to conduct a meta-analysis of experimental studies testing juvenile diversion programs and to examine the moderating effect of program type and implementation quality. METHOD A literature search using PsycINFO, Web of Science, and the National Criminal Justice Reference Service data-bases and research institute websites yielded 28 eligible studies involving 57 experimental comparisons and 19,301 youths. RESULTS Recidivism was the most common outcome reported across all studies. Overall, the effect of diversion programs on recidivism was non-significant (k=45, OR=0.83, 95%CI=0.43-1.58). Of the five program types identified, including case management (k=18, OR=0.78), individual treatment (k=11, OR=0.83), family treatment (k=4, OR=0.57), youth court (k=6, OR=0.93), and restorative justice (k=6, OR=0.87), only family treatment led to a statistically significant reduction in recidivism. Restorative justice studies that were implemented with active involvement of researchers led to statistically significant reductions in recidivism (k=3, OR=0.69). Other outcomes, including frequency of offending, truancy, and psycho-social problems were reported infrequently and were not subjected to meta-analysis. CONCLUSIONS High levels of heterogeneity characterize diversion research. Results of this study recommend against implementation of programs limited to case management and highlight the promise of family interventions and restorative justice.
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Affiliation(s)
- Craig S Schwalbe
- Columbia University School of Social Work, 1255 Amsterdam ave., New York, New York 10027, USA.
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Therapist training in empirically supported treatments: a review of evaluation methods for short- and long-term outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2011; 38:254-86. [PMID: 21656256 DOI: 10.1007/s10488-011-0360-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Therapist training efforts have been assessed using several outcomes. A model for evaluating therapist training in empirically supported treatments is presented, adapted from Kirkpatrick's (in: Craig and Bittel (eds.) Training and development handbook, 1967) training evaluation model. The adapted framework includes short-term outcomes, such as reactions to training and changes in attitude, knowledge, or skills, and longer-term outcomes, such as changes in therapist behavior in practice or client outcomes. Evaluation methods for these outcomes are reviewed, with information on their validity, reliability, and feasibility. An agenda for further research to improve therapist training evaluation is presented, with discussion of how evaluation can inform other areas of the field.
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Garland AF, Bickman L, Chorpita BF. Change what? Identifying quality improvement targets by investigating usual mental health care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2010; 37:15-26. [PMID: 20177769 PMCID: PMC2874058 DOI: 10.1007/s10488-010-0279-y] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Efforts to improve community-based children’s mental health care should be based on valid information about effective practices and current routine practices. Emerging research on routine care practices and outcomes has identified discrepancies between evidence-based practices and “usual care.” These discrepancies highlight potentially potent quality improvement interventions. This article reviews existing research on routine or “usual care” practice, identifies strengths and weaknesses in routine psychotherapeutic care, as well as gaps in knowledge, and proposes quality improvement recommendations based on existing data to improve the effectiveness of children’s mental health care. The two broad recommendations for bridging the research-practice gap are to implement valid, feasible measurement feedback systems and clinician training in common elements of evidence-based practice.
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Affiliation(s)
- Ann F Garland
- University of California-San Diego, 3020 Children's Way, San Diego, CA, 92123, USA.
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21
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Bunger AC. Defining Service Coordination: A Social Work Perspective. JOURNAL OF SOCIAL SERVICE RESEARCH 2010; 36:385-401. [PMID: 21116470 PMCID: PMC2992332 DOI: 10.1080/01488376.2010.510931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
To address fragmentation, social workers are encouraged to "coordinate." This pilot study explores the meaning of, and factors that facilitate or prevent "coordination" and is intended as a first step toward future conceptual refinement, theory development, and system interventions. Using data from treatment guidelines archived by the National Guideline Clearinghouse (n=9) and semi-structured interviews with social workers (n=4), themes related to the definition, indicators, and perceptions of coordination were explored using a grounded theory approach. Data suggest the need for coordination is driven by complex client needs, but the quality of providers' personal relationships influence coordination. Future research might examine the impact of standardization of roles, referral procedures, and treatment philosophies.
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Affiliation(s)
- Alicia C. Bunger
- NIMH Pre-doctoral Trainee, The Brown School of Social Work, Washington University, Campus Box 1196, 1 Brookings Drive, St Louis, MO 63130
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Bellamy JL, Gopalan G, Traube DE. A national study of the impact of outpatient mental health services for children in long-term foster care. Clin Child Psychol Psychiatry 2010; 15:467-79. [PMID: 20923897 PMCID: PMC3049724 DOI: 10.1177/1359104510377720] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the tremendous mental health need evidenced by children in foster care and high rates of use of mental health services among children in foster care, little is known about the impact of outpatient mental health services on the behavioral health of this population. This study utilizes data from the National Survey of Child and Adolescent Well-being (NSCAW), the first nationally representative study of child welfare in the United States. A subsample of 439 children who have experienced long-term foster care were included in this study. These data were used to estimate the impact of outpatient mental health services on the externalizing and internalizing behavior problems of children in long-term foster care. A propensity score matching model was employed to produce a robust estimate of the treatment effect. Results indicate that children who have experienced long-term foster care do not benefit from the receipt of outpatient mental health services. Study results are discussed in the context of earlier research on the quality of mental health services for children in foster care.
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Huefner JC, James S, Ringle J, Thompson RW, Daly DL. Patterns of movement for youth within an integrated continuum of residential services. CHILDREN AND YOUTH SERVICES REVIEW 2010; 32:10.1016/j.childyouth.2010.02.005. [PMID: 24273361 PMCID: PMC3835816 DOI: 10.1016/j.childyouth.2010.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study examined patterns of movement for youth receiving services within a continuum of intensive and restrictive residentially-based programs. Data were collected for 701 completed episodes of care within a three-program residential continuum of care over a 5 year period, and examined time within program, movement between programs, in-program disruptive behavior, and discharge status. Results showed that most youth either remained in a stable placement in the least restrictive of the programs, or followed a pattern of placements that systematically moved them from more restrictive to less restrictive settings. Of note, transitions from more restrictive to less restrictive programs correspond to deescalating levels of problem behavior; and over 80% of the youth were stepped down to either family-based or independent living situations at the time of departure. Findings support the notion that a continuum of intensive residential services can serve the needs of youth with significant emotional and behavioral needs.
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Foster EM, Wiley-Exley E, Bickman L. Old wine in new skins: the sensitivity of established findings to new methods. EVALUATION REVIEW 2009; 33:281-306. [PMID: 19351888 DOI: 10.1177/0193841x09334028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Findings from an evaluation of a model system for delivering mental health services to youth were reassessed to determine the robustness of key findings to the use of methodologies unavailable to the original analysts. These analyses address a key concern about earlier findings-that the quasi-experimental design involved the comparison of two noncomparable groups. The authors employed propensity score methodology to reconsider between-group baseline differences in observed characteristics of participating families. The authors also considered the possible effect of unobserved between-group differences. The data support previous studies that show few differences in outcomes, but the findings are sensitive to unobserved heterogeneity.
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Affiliation(s)
- E Michael Foster
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Rosenau Hall, Chapel Hill, NC 27599-7445, USA.
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Bai Y, Wells R, Hillemeier MM. Coordination between child welfare agencies and mental health service providers, children's service use, and outcomes. CHILD ABUSE & NEGLECT 2009; 33:372-81. [PMID: 19473702 PMCID: PMC2694225 DOI: 10.1016/j.chiabu.2008.10.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2007] [Revised: 09/25/2008] [Accepted: 10/05/2008] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Interorganizational relationships (IORs) between child welfare agencies and mental health service providers may facilitate mental health treatment access for vulnerable children. This study investigates whether IORs are associated with greater use of mental health services and improvement in mental health status for children served by the child welfare system. METHODS This was a longitudinal analysis of data from a 36-month period in the National Survey of Child and Adolescent Well-Being (NSCAW). The sample consisted of 1,613 children within 75 child welfare agencies who were 2 years or older and had mental health problems at baseline. IOR intensity was measured as the number of coordination approaches between each child welfare agency and mental health service providers. Separate weighted multilevel logistic regression models tested associations between IORs and service use and outcomes, respectively. RESULTS Agency-level factors accounted for 9% of the variance in the probability of service use and 12% of mental health improvement. Greater intensity of IORs was associated with higher likelihood of both service use and mental health improvement. CONCLUSIONS Having greater numbers of ties with mental health providers may help child welfare agencies improve children's mental health service access and outcomes. PRACTICE IMPLICATIONS Policymakers should develop policies and initiatives to encourage a combination of different types of organizational ties between child welfare and mental health systems. For instance, information sharing at the agency level in addition to coordination at the case level may improve the coordination necessary to serve these vulnerable children.
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Affiliation(s)
- Yu Bai
- Department of Health Policy and Administration, Pennsylvania State University, 604 Ford Building, University Park, PA 16802, USA
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Shannon LM, Walker R, Blevins M. Developing a new system to measure outcomes in a service coordination program for youth with severe emotional disturbance. EVALUATION AND PROGRAM PLANNING 2009; 32:109-118. [PMID: 19019436 DOI: 10.1016/j.evalprogplan.2008.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 09/15/2008] [Accepted: 09/16/2008] [Indexed: 05/27/2023]
Abstract
This paper presents information on re-developing an outcome evaluation for a state-funded program providing service coordination utilizing wraparound to youth with severe emotional disturbance (SED) and their families. Originally funded by the Robert Wood Johnson Foundation, the Kentucky IMPACT program has existed statewide since 1990. Changing data needs and limitations of the original evaluation required revamping the program's data collection system. The new evaluation uses the extant knowledge base to improve: (1) design, (2) measures, and (3) utility. A pre-post design with multiple follow-ups provides the framework for data collection. An ecological framework provides a conceptual structure for selecting measures focusing on both the service recipients and their environment. Data collection via a personal digital assistant (PDA) ensures utility of the data for both consumers and researchers. Issues ranging from conceptualization to implementation of the project as well as lessons learned are discussed.
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Affiliation(s)
- Lisa M Shannon
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40536-9824, United States.
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27
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Isett KR, Burnam MA, Coleman-Beattie B, Hyde PS, Morrissey JP, Magnabosco JL, Rapp C, Ganju V, Goldman HH. The role of state mental health authorities in managing change for the implementation of evidence-based practices. Community Ment Health J 2008; 44:195-211. [PMID: 17924189 DOI: 10.1007/s10597-007-9107-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 09/07/2007] [Indexed: 10/22/2022]
Abstract
The evidence-based practice demonstration for services to adults with serious mental illness has ended its pilot stage. This paper presents the approaches states employed to combine traditional policy levers with more strategic/institutional efforts (e.g., leadership) to facilitate implementation of these practices. Two rounds of site visits were completed and extensive interview data collected. The data were analyzed to find trends that were consistent across states and across practices. Two themes emerged for understanding implementation of evidence-based practices: the support and influence of the state mental health authority matters and so does the structure of the mental health systems.
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Affiliation(s)
- Kimberley Roussin Isett
- Department of Health Policy and Management, Columbia University, 600 West 168th Street, New York, NY 10032, USA.
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Guevara JP, Greenbaum PE, Shera D, Shea JA, Bauer L, Schwarz DF. Development and psychometric assessment of the collaborative care for attention-deficit disorders scale. ACTA ACUST UNITED AC 2008; 8:18-24. [PMID: 18191777 DOI: 10.1016/j.ambp.2007.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 10/10/2007] [Accepted: 10/13/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the development and assess the validity and reliability of the Collaborative Care for Attention-Deficit Disorders Scale (CCADDS), a measure of collaborative care processes for children with attention-deficit/hyperactivity disorder who attend primary care practices. METHODS Collaborative care was conceptualized as a multidimensional construct. The 41-item CCADDS was developed from an existing instrument, review of the literature, focus groups, and an expert panel. The CCADDS was field tested in a national mail survey of 600 stratified and randomly selected practicing general pediatricians. Psychometric analysis included assessments of factor structure, construct validity, and internal consistency. RESULTS The overall response rate was 51%. Most respondents were male (56%), 46 years old or older (59%), and white (69%). Common factor analysis identified 3 subscales: beliefs, collaborative activities, and connectedness. Internal consistency reliability (coefficient alpha) for the overall scale was .91, and subscale scores ranged from .80 to .89. The CCADDS correlated with a validated measure of provider psychosocial orientation (r = -.36, P < .001) and with self-reported frequency of mental health referrals or consultations (r = -.24 to -.42, P < .001). CCADDS scores were similar among physicians by race/ethnicity, gender, age group, and practice location. CONCLUSIONS Scores on the CCADDS were reliable for measuring collaborative care processes in this sample of primary care clinicians who provide treatment for children with attention-deficit/hyperactivity disorder. Evidence for validity of scores was limited. Future research is needed to confirm its psychometric properties and factor structure and provide guidance on score interpretation.
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Affiliation(s)
- James P Guevara
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Bates MP, Furlong MJ, Green JG. Are CAFAS subscales and item weights valid? A preliminary investigation of the Child and Adolescent Functional Assessment Scale. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2007; 33:682-95. [PMID: 16775756 DOI: 10.1007/s10488-006-0052-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Presents a psychometric analysis of the Child and Adolescent Functional Assessment Scale (CAFAS), one of the most commonly used measures of functional impairment in youths with emotional and behavioral disorders. Specific aims of the current investigation were to (a) examine the conceptual organization of the CAFAS items, (b) explore its scaling properties, and (c) investigate its construct validity. In Phase 1, a group of advanced graduate students and clinicians rated CAFAS items with respect to the degree that they reflect the originally assigned subscales. In Phase 2, additional raters assigned severity values to the subset of CAFAS items selected from Phase 1. Items were then scaled using simplified successive intervals scaling techniques. Results show differences between new empirically derived item weights and the original scoring method. This investigation highlights the benefits of continued examination and critique of level-of-functioning scaling for diagnosis, treatment, and prognosis in children and adolescents.
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Affiliation(s)
- Michael P Bates
- Counseling, Clinical, & School Psychology Program, Gevirtz Graduate School of Education, Center for School-Based Youth Development, University of California, Santa Barbara, CA 93106-9490, USA.
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Pfefferle SG, Gittell JH, Hodgkin D, Ritter G. Pediatrician Coordination of Care for Children with Mental Illnesses. Med Care 2006; 44:1085-91. [PMID: 17122712 DOI: 10.1097/01.mlr.0000237177.11301.35] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children with mental illnesses are seen across various service sectors, including pediatric primary care. As such, care coordination, which has been shown to improve outcomes, is especially important. Little is known about organizational and state level factors that might affect pediatricians' efforts to coordinate care for children with mental illnesses. OBJECTIVES This study used data from a survey of primary care pediatricians to examine organizational and state level variables associated with increased care coordination for children with mental illnesses. METHODS We undertook a cross-sectional study using data from a survey of pediatricians. A total of 1337 pediatricians in 6 states were surveyed about their care coordination and about organizational characteristics. State level data were gathered from various sources. A 5-item scale was developed for the dependent variable of past month coordination contacts (Cronbach's alpha = 0.82). RESULTS No state level variables were associated with pediatrician coordination behaviors. Having a regular case conferencing mechanism, staff assigned to coordinate care, and a mental health specialist in the practice were associated with increased past month coordination contacts. Pediatricians in rural practices coordinated care more frequently than those in other locations. Pediatricians who screened more and those with more experience had higher rates of care coordination. CONCLUSIONS Having a regular case conferencing mechanism, staff assigned to coordinate care, and a mental health specialist in the practice were associated with increased mental health care coordination. This information should be useful in planning ways to increase care coordination for children with mental illnesses seen in pediatric primary care.
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Affiliation(s)
- Susan G Pfefferle
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA.
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Wilson DB, Shadish WR. On blowing trumpets to the tulips: to prove or not to prove the null hypothesis--comment on Bösch, Steinkamp, and Boller (2006). Psychol Bull 2006; 132:524-8; discussion 533-7. [PMID: 16822163 DOI: 10.1037/0033-2909.132.4.524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The H. Bösch, F. Steinkamp, and E. Boller meta-analysis reaches mixed and cautious conclusions about the possibility of psychokinesis. The authors argue that, for both methodological and philosophical reasons, it is nearly impossible to draw any conclusions from this body of research. The authors do not agree that any significant effect at all, no matter how small, is fundamentally important (Bösch et al., 2006, p. 517), and they suggest that psychokinesis researchers focus either on producing larger effects or on specifying the conditions under which they would be willing to accept the null hypothesis.
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Affiliation(s)
- David B Wilson
- Department of Public and International Affairs, George Mason University, Manassas, VA 20110, USA.
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My life as an applied social psychologist. CURRENT PSYCHOLOGY 2006. [DOI: 10.1007/s12144-006-1005-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- Roger A Boothroyd
- Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, MHC 2719, University of South Florida, 13301, Tampa, FL 33612, USA.
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Geller JL, Biebel K. The premature demise of public child and adolescent inpatient psychiatric beds : Part II: challenges and implications. Psychiatr Q 2006; 77:273-91. [PMID: 16927166 DOI: 10.1007/s11126-006-9013-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Psychiatric disorders are the leading reason for hospitalization among 5-19 year olds. Current data, however, suggest there are fewer than necessary available services for children and adolescents requiring intensive, inpatient psychiatric care. Children and adolescents with behavioral health problems, the majority of whom do not receive appropriate treatment, have increased risk of school failure, family disruption, out-of-home placements, poor employment opportunities, and poverty in adulthood. This paper will examine the challenges inherent in serving children and adolescents with serious emotional disturbances, avenues of financing for treatment and services, and various loci of intervention for high-risk children, including inpatient settings and systems of care. The goals of this paper are to illustrate the complexities of working with children and adolescents most in need of intensive psychiatric services, to explore how inpatient services "fit" into existing treatment approaches, and to discuss the efficacy of downsizing or closing inpatient psychiatric units for this population.
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Affiliation(s)
- Jeffrey L Geller
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
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Abstract
A systematic review was undertaken of scientifically rigorous studies of family-based services in children's health and mental health. From a pool of over 4000 articles since 1980 in health and mental health that examined either specific family-based interventions for families of children or the processes of involvement, 41 studies were identified that met the methodological criteria for inclusion. These 41 studies encompassed 3 distinct categories: families as recipients of interventions (e.g., family education, support, engagement, empowerment); (b) families as co-therapists; and (c) studies of the processes of involvement (e.g., therapeutic alliance, engagement, empowerment, expectancies, and choice). Too few experimental studies exist to conclude decisively that family-based services improve youth clinical outcomes. However, those studies that have been rigorously examined demonstrate unequivocal improvements in other types of outcomes, such as retention in services, knowledge about mental health issues, self-efficacy, and improved family interactions - all outcomes that are essential ingredients of quality care. Four implications are drawn from this review. (1) Effective family education and support interventions from studies of adults with mental illnesses and from studies of families of high-risk infants exist and can be imported into the field of children's mental health. (2) The range of outcomes that are typically assessed in clinical treatment studies is too narrow to afford an adequate view of the impact of family-based interventions. A broader view of outcomes is needed. (3) The absence of a robust literature on process variables other than therapeutic alliance limits conclusions about how and why interventions are effective. Attention to the processes by which families become involved in services will require a more robust and nuanced range of studies that attend simultaneously to processes of change and to outcome improvement. (4) Linkage of effective family-based interventions to delivery of evidence-based services is likely to amplify the impact of those services and improve outcomes for youth and families.
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Cretin S, Shortell SM, Keeler EB. An evaluation of collaborative interventions to improve chronic illness care. Framework and study design. EVALUATION REVIEW 2004; 28:28-51. [PMID: 14750290 DOI: 10.1177/0193841x03256298] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The author's dual-purpose evaluation assesses the effectiveness of formal collaboratives in stimulating organizational changes to improve chronic illness care (the chronic care model or CCM). Intervention and comparison sites are compared before and after introduction of the CCM. Multiple data sources are used to measure the degree of implementation, patient-level processes and outcomes, and organizational and team factors associated with success. Despite challenges in timely recruitment of sites and patients, data collection on 37 participating organizations, 22 control sites, and more than 4,000 patients with diabetes, congestive heart failure, asthma, or depression is nearing completion. When analyzed, these data will shed new light on the effectiveness of collaborative improvement methods and the CCM.
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Chorpita BF, Nakamura BJ. Four considerations for dissemination of intervention innovations. ACTA ACUST UNITED AC 2004. [DOI: 10.1093/clipsy.bph093] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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40
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Ollendick TH, Davis TE. Empirically supported treatments for children and adolescents: Where to from here? ACTA ACUST UNITED AC 2004. [DOI: 10.1093/clipsy.bph083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Herschell AD, McNeil CB, McNeil DW. Clinical child psychology's progress in disseminating empirically supported treatments. ACTA ACUST UNITED AC 2004. [DOI: 10.1093/clipsy.bph082] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Henggeler SW, Rowland MD, Halliday-Boykins C, Sheidow AJ, Ward DM, Randall J, Pickrel SG, Cunningham PB, Edwards J. One-year follow-up of multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis. J Am Acad Child Adolesc Psychiatry 2003; 42:543-51. [PMID: 12707558 DOI: 10.1097/01.chi.0000046834.09750.5f] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study presents findings from a 1-year follow-up to a randomized clinical trial comparing multisystemic therapy (MST), modified for use with youths presenting psychiatric emergencies, with inpatient psychiatric hospitalization. METHOD One hundred fifty-six children and adolescents approved for emergency psychiatric hospitalization were randomly assigned to home-based MST or inpatient hospitalization followed by usual services. Assessments examining mental health symptoms, out-of-home placement, school attendance, and family relations were conducted at five times: within 24 hours of recruitment, shortly after the hospitalized youth was released from the hospital (1-2 weeks after recruitment), at the completion of MST (average of 4 months postrecruitment), and 10 and 16 months postrecruitment. RESULTS Based on placement and youth-report measures, MST was initially more effective than emergency hospitalization and usual services at decreasing youths' symptoms and out-of-home placements and increasing school attendance and family structure, but these differences generally dissipated by 12 to 16 months postrecruitment. Hospitalization produced a rapid, but short-lived, decrease in externalizing symptoms based on caregiver reports. CONCLUSION Findings suggest that youths with serious emotional disturbance might benefit from continuous access to a continuum of evidence-based practices titrated to clinical need.
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Affiliation(s)
- Scott W Henggeler
- Department of Psychiatry and Behavioral Sciences, Family Services Research Center, Medical University of South Carolina, 67 President Street, Suite CPP, Box 250861, Charleston, SC 29425, USA.
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Thompson MJJ, Coll X, Wilkinson S, Uitenbroek D, Tobias A. Evaluation of a Mental Health Service for Young Children: Development, Outcome and Satisfaction. Child Adolesc Ment Health 2003; 8:68-77. [PMID: 32797556 DOI: 10.1111/1475-3588.00049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Over a 10-year period (1984-1996) a child guidance clinic developed a service in the community for parents with young children with mental health problems. This included support for primary care staff and training courses. The clinical input to the young children developed from a clinic within the child guidance clinic (1984-87), to a specialist clinic for under fives (1990-91) to a service run by a nurse in the community (1994-95), with nurses referring to colleagues only the more complicated cases. METHOD The work in 1990-91 was compared with the work in 1994-95. The family and clinic scored the outcome of the work, by recording the severity of the problem, separately, on unanchored 5-point Likert scales before and after treatment. For the evaluation in 1994-95 a satisfaction questionnaire was also developed. The cost of running the two different clinics was calculated. RESULTS The results indicated that there was a slight fall in the effect size for the clinical work in 1994-95, but this method of working was two-thirds of the cost of the previous clinic. The parents were satisfied with both services. The post-contact parental satisfaction questionnaire had face validity, construct validity and internal consistency. CONCLUSIONS Nurses working on their own in the community can be a cost effective method for working with families with young children. Some families will need to be referred on to specialist teams and more work needs to be done to establish which families and when referral is appropriate. The questionnaire was shown to be a valid and reliable way of assessing family satisfaction.
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Affiliation(s)
- Margaret J J Thompson
- Child and Adolescent Mental Health Services, Ashurst Hospital, Lyndhurst Road, Southampton SO4 7AR, UK
| | - Xavier Coll
- University of East Anglia, Bethel Child and Family Centre, Mary Chapman House, Hotblack Road, Norwich NR2 4HN, UK
| | | | - Daan Uitenbroek
- Formerly Research and Development Unit, TARDIS, Stern Road, Tatchbury Mount, Southampton, UK
| | - Aurelio Tobias
- Department of Clinical Epidemiology and Public Health, Hospital de la Creu i Sant Pau, Universitat Autònoma of Barcelona, Barcelona, Spain
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Bickman L. The death of treatment as usual: An excellent first step on a long road. ACTA ACUST UNITED AC 2002. [DOI: 10.1093/clipsy.9.2.195] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Pincus HA, Pechura CM, Elinson L, Pettit AR. Depression in primary care: linking clinical and systems strategies. Gen Hosp Psychiatry 2001; 23:311-8. [PMID: 11738461 DOI: 10.1016/s0163-8343(01)00165-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Depression is a serious, often chronic disease that can be managed effectively with a chronic care model in primary care settings. Depressed persons are likely to be seen by a primary care physician, but their condition often goes unrecognized and untreated. There are effective treatment models that consist of efficacious psychotherapeutic and pharmacological interventions, use of evidence-based guidelines for primary care treatment of depression, development of explicit plans and protocols, reorganization of practice, longitudinal follow-up, patient self-management, decision-making support, access to community resources and leadership commitment. Moving these models into everyday practice requires overcoming both clinical and system barriers. Barriers consist of issues surrounding patients, providers, practices, plans, and purchasers. An understanding of these barriers at each level helps to provide a framework for the changes required to overcome them. The Robert Wood Johnson Foundation National Program on Depression in Primary Care will seek to apply simultaneously both clinical and system strategies in a new five-year initiative to overcome these barriers.
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Affiliation(s)
- H A Pincus
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Lambert EW, Doucette A, Bickman L. Measuring mental health outcomes with pre-post designs. J Behav Health Serv Res 2001; 28:273-86. [PMID: 11497023 DOI: 10.1007/bf02287244] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The pre-post design has been the workhorse of outcome evaluations for many years. Using data from a study of 984 treated children (ages 5 to 17 years), this article argues that there are two structural problems with the pre-post evaluation of outcome: (1) excessively large intervals of uncertainty for individual outcomes and (2) paradoxical inconsistencies in the evaluation of groups. These problems can be solved by designs with three or more repeated measures analyzed with longitudinal multilevel analytic models.
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Affiliation(s)
- E W Lambert
- Center for Mental Health Policy, Vanderbilt University, Nashville 37212, USA.
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Lambert EW, Wahler RG, Andrade AR, Bickman L. Looking for the disorder in conduct disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2001; 110:110-23. [PMID: 11265675 DOI: 10.1037/0021-843x.110.1.110] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Besides their well-known externalizing behavior, children with conduct disorder (CD) often have additional impairments outside the criteria for the CD diagnosis. In a 5-year study of 984 treated children (ages 5-17 years), those with CD had an average of 2.2 primary diagnoses. Children with CD showed the worst problem and impairment scores in comparison with 11 common diagnoses. Compared with other treated children, children with CD achieved worse scores on 14 of 15 syndromes, including internalizing problems such as withdrawal and major depression. The average child with CD had larger relapse scores in the 1.5- to 3-year period after admission to treatment. This pattern, pervasive at intake and chronic in course, resembles a global disability more than a circumscribed problem managed with a narrow range of treatments specific to it.
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Affiliation(s)
- E W Lambert
- Center for Mental Health Policy, Vanderbilt University, 1207 18th Avenue South, Nashville, Tennessee 37212, USA.
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