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Castonguay LG, Youn SJ, Boswell JF, Kilcullen JR, Xiao H, McAleavey AA, Boutselis MA, Braver M, Chiswick NR, Hemmelstein NA, Jackson JS, Lytle RA, Morford ME, Scott HS, Spayd CS, O'Leary Wiley M. Therapeutic techniques and session impact: A practice-research network study in private practice. Psychother Res 2024; 34:845-857. [PMID: 37946364 DOI: 10.1080/10503307.2023.2262099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 11/12/2023] Open
Abstract
Objective: This study investigated the relationship between therapeutic techniques and session impact, by examining the replicability of findings observed in a university-based training clinic (Boswell et al., 2010) in another practice-oriented setting: private practice. Method: N = 8 therapists completed session-level assessments of their technique use for N = 38 clients. The same client sample completed session-level assessments of session outcome. Technique-outcome associations were examined with multilevel models. Results: As in Boswell et al., common factors were associated with positive session impact. For clients who received higher average common factor techniques (relative to their own therapist's caseload), session impact was the poorest in sessions with higher behavioral change techniques use (relative to the client's own average). Moreover, clients with the lowest average common factor techniques (relative to their therapist's caseload) reported better session impact in sessions that involved a higher degree of session-level behavioral change techniques (relative to their own average). Conclusion: In line with Boswell et al., therapists should be mindful of the consistency of their routine technique use between- and within-clients, and this can be aided through collection of their own practice-oriented data.
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Affiliation(s)
| | - Soo Jeong Youn
- Reliant Medical Group, Optum Care, Harvard Medical School, Boston, MA, USA
| | - James F Boswell
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
| | - J Ryan Kilcullen
- Department of Psychology, Penn State University, State College, PA, USA
| | - Henry Xiao
- Counseling and Psychological Services, Penn State University, State College, PA, USA
| | - Andrew A McAleavey
- District General Hospital of Førde, Førde, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
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Yount KM, Whitaker DJ, Fang X, Trang QT, Macaulay M, Minh TH. Strategies for Implementing GlobalConsent to Prevent Sexual Violence in University Men (SCALE): study protocol for a national implementation trial. Trials 2024; 25:571. [PMID: 39210388 PMCID: PMC11360798 DOI: 10.1186/s13063-024-08401-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Globally, women 15-24 years are at heightened risk of sexual violence victimization, a risk factor for adverse mental, physical, and behavioral health outcomes. Sexual violence is common at universities and most often perpetrated by men, yet few evidence-based prevention strategies targeting men have been tested in low- and middle-income countries. GlobalConsent is a six-module, web-based educational program adapted from an efficacious U.S.-based program. Nine months post-treatment in a randomized trial in Vietnam, GlobalConsent reduced men's sexually violent behavior (odds ratio [OR] = 0.71, 95%CI 0.50-1.00) and increased prosocial intervening behavior (OR = 1.51, 1.00-2.28) relative to an attention-control. Evidence regarding optimal implementation strategies for scale up is needed. METHODS We will randomize six medical universities in North, Central, and South Vietnam to deliver GlobalConsent using two different packages of implementation strategies that vary in intensity. Higher-intensity strategies will include greater (1) pre- and post-implementation engagement with university leaders and faculty and (2) greater pre-implementation outreach, follow-up, and incentives for students to promote engagement and completion of GlobalConsent. Higher intensity universities will receive additional training and support for their added activities. We will compare implementation drivers and outcomes, intervention effectiveness, and cost-effectiveness across the two implementation bundles. Our mixed-methods comparative interrupted time series design includes (1) qualitative interviews and quantitative surveys with university leaders and implementation teams to assess implementation barriers and facilitators; (2) repeated surveys with leaders and faculty, implementation teams, and male students to assess multilevel implementation drivers and outcomes; (3) repeated surveys with male students to assess behavioral outcomes (sexual violence and intervening behavior) and mediating variables (knowledge, attitudes, affect, and capacities); and (4) time diaries and cost tracking to assess cost-effectiveness of the two implementation-strategies bundles. DISCUSSION This project is the first to assess packages of implementation strategies to deliver an efficacious web-based sexual violence prevention program for undergraduate men across all regions of Vietnam and synergizes with a violence-prevention training initiative (D43TW012188). This approach will produce rigorous evidence about how to disseminate GlobalConsent nationally, which holds promise to reduce gender-based health inequities linked to sexual violence as GlobalConsent is brought to scale. TRIAL REGISTRATION NCT06443541. Retrospectively registered with ClinicalTrials.gov. Registered on June 05, 2024.
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Affiliation(s)
| | | | | | - Quach Thu Trang
- Center for Creative Initiatives in Health and Population, Hanoi, Vietnam
| | | | - Tran Hung Minh
- Center for Creative Initiatives in Health and Population, Hanoi, Vietnam
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Blok AC, Drake C, Decosimo K, Zullig LL, Hughes JM, Sperber NR, Kota S, Franzosa E, Coffman CJ, Shepherd-Banigan M, Chadduck T, Allen KD, Hastings SN, Van Houtven CH. Adaptations and early adoption of a family caregiver intervention in the Veterans Affairs Health Care System: A multimethod pragmatic approach for national scaling. Health Serv Res 2024. [PMID: 39090785 DOI: 10.1111/1475-6773.14360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVE To examine the relationship between site-level adaptation and early adoption of Caregivers Finding Important Resources, Support, and Training (FIRST) training during national implementation across diverse Veteran Health Administration (VA) medical centers. DATA SOURCES AND STUDY SETTING We enrolled and evaluated 25 VA medical centers (VAMCs). Along with administrative data on site characteristics, we examined site-reported data on adaptations and intervention adoption, defined as ≥4 training classes delivered to ≥5 caregivers at 6 months from April through October 2022. STUDY DESIGN A type III hybrid implementation-effectiveness cluster randomized controlled trial, randomized VAMCs 1:1 to receive foundational (low-touch) implementation support (n = 12) or the addition of enhanced (high-touch) implementation support (n = 13). DATA COLLECTION/EXTRACTION METHODS At key implementation phases, VAMCs were asked to report adaptations including content, contextual modifications (format, setting, personnel, and population), and training of providers. We describe site-level adaptations by arm and by organizational characteristics that included VAMC complexity level, staffing, rurality, and organizational readiness to change. We used qualitative comparative analysis to identify unique adaptations that contributed to intervention adoption at 6 months. PRINCIPAL FINDINGS VAMCs randomized to receive enhanced support reported slightly more adaptations than those randomized to foundational support. At 6 months, VAMCs with two or more adaptations adopted Caregivers FIRST at a higher rate than those with fewer adaptations (90% vs. 44%). Staffing adaptations (e.g., who delivered the intervention), format and content (e.g., modified delivery pace), and referring provider training were unique adaptations to adopting sites. CONCLUSIONS Site-level adaptations were diverse and occurred more frequently in sites with early adoption of Caregivers FIRST. Future research should identify best practices of supporting and monitoring intervention adaptation. Understanding the role of adaptation in early adoption success could assist other healthcare systems in implementing interventions for caregivers.
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Affiliation(s)
- Amanda C Blok
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Connor Drake
- Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kasey Decosimo
- Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Leah L Zullig
- Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jaime M Hughes
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Section on Gerontology and Geriatric Medicine, Division of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Nina R Sperber
- Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Swetha Kota
- Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Emily Franzosa
- James J. Peters VA Medical Center, Geriatric Research, Education and Clinical Center, Bronx, New York, USA
- Icahn School of Medicine at Mount Sinai, Brookdale Department of Geriatrics and Palliative Medicine, New York, New York, USA
| | - Cynthia J Coffman
- Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Megan Shepherd-Banigan
- Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
| | - Trisha Chadduck
- Veteran's Health Administration Central Office, Washington, DC, USA
| | - Kelli D Allen
- Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Susan N Hastings
- Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Courtney H Van Houtven
- Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
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Raghavan R, Fitzsimmons-Craft EE, Welch RR, Jo B, Proctor EK, Wilson GT, Agras WS, Wilfley DE. Cost-effectiveness of train-the-trainer versus expert consultation training models for implementing interpersonal psychotherapy in college mental health settings: evidence from a national cluster randomized trial. Implement Sci 2024; 19:55. [PMID: 39075590 PMCID: PMC11287912 DOI: 10.1186/s13012-024-01388-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/22/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND This study is a cost-effectiveness study of two implementation strategies designed to train therapists in college and university counseling centers to deliver interpersonal psychotherapy. Costs of implementing a train-the-trainer (TTT) strategy versus an expert consultation strategy were estimated, and their relative effects upon therapist outcomes were calculated and compared. METHODS Twenty four counseling centers were recruited across the United States. These centers were randomized to either a TTT (experimental) condition, in which an in-house therapist trained other center therapists, or an expert consultation condition, in which center therapists participated in a workshop and received 12 months of ongoing supervision. The main outcome was therapist fidelity (adherence and competence) to interpersonal psychotherapy, assessed via audio recordings of therapy sessions, and analyzed using linear mixed models. Costs of each condition were quantified using time-driven activity-based costing methods, and involved a costing survey administered to center directors, follow up interviews and validation checks, and comparison of time tracking logs of trainers in the expert condition. Mean costs to produce one therapist were obtained for each condition. The costs to produce equivalent improvements in therapist-level outcomes were then compared between the two conditions. RESULTS Mean cost incurred by counseling centers to train one therapist using the TTT strategy was $3,407 (median = $3,077); mean cost to produce one trained therapist in the control condition was $2,055 (median = $1,932). Therapists in the TTT condition, on average, demonstrated a 0.043 higher adherence score compared to therapists in the control condition; however, this difference was not statistically significant. For the competence outcome, effect size for therapists in the TTT condition was in the large range (1.16; 95% CI: 0.85-1.46; p < .001), and therapists in this condition, on average, demonstrated a 0.073 higher competence score compared to those in the expert consultation condition (95% CI, 0.008-0.14; p = .03). Counseling centers that used the TTT model incurred $353 less in training costs to produce equivalent improvements in therapist competence. CONCLUSIONS Despite its higher short run costs, the TTT implementation strategy produces greater increases in therapist competence when compared to expert consultation. Expanding resources to support this platform for service delivery can be an effective way to enhance the mental health care of young people seeking care in college and university counseling centers. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02079142.
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Affiliation(s)
- Ramesh Raghavan
- New York University, Silver School of Social Work, New York, NY, US.
| | | | - R Robinson Welch
- Washington University in St. Louis, School of Medicine, Department of Psychiatry, St. Louis, MO, US
| | - Booil Jo
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, CA, US
| | - Enola K Proctor
- Washington University in St. Louis, Brown School, St. Louis, MO, US
| | - G Terence Wilson
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, US
| | - W Stewart Agras
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, CA, US
| | - Denise E Wilfley
- Washington University in St. Louis, School of Medicine, Department of Psychiatry, St. Louis, MO, US
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Bartuska AD, Eaton EL, Akinrimisi P, Kim R, Cheron DM, Park AL. Provider Adherence to Modular Cognitive Behavioral Therapy for Children and Adolescents. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:597-609. [PMID: 38334882 DOI: 10.1007/s10488-024-01353-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 02/10/2024]
Abstract
This study explored predictors of community-based providers' adherence to MATCH, a modular cognitive behavioral therapy for children and adolescents. Provider-reported adherence to MATCH was measured using three increasingly strict criteria: (1) session content (whether the session covered MATCH content consistent with the client's target problem), (2) session content and sequencing (whether the session covered MATCH content in the expected sequence for the client's target problem), and (3) session content, sequencing, and participant (whether the session covered MATCH content in the expected sequence and with the expected participant(s) for the client's target problem). Session, client, provider, and organizational predictors of adherence to MATCH were assessed using multilevel modeling. Results revealed that nearly all providers delivered MATCH content that corresponded to the target problem, but only one-third of providers delivered MATCH content in the expected sequence and with the expected participant for the client's target problem. This difference underscores the need for nuanced adherence measurement to capture important implementation information that broad operationalizations of adherence miss. Regardless of the criteria used providers were most adherent to MATCH during sessions when clients presented with interfering comorbid mental health symptoms. This suggests that the design of MATCH, which offers flexibility and structured guidance to address comorbid mental health problems, may allow providers to personalize treatment to address interfering comorbidity symptoms while remaining adherent to evidence-based practices. Additional guidance for providers on managing other types of session interference (e.g., unexpected events) may improve treatment integrity in community settings.
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Affiliation(s)
- Anna D Bartuska
- Department of Psychology, University of Oregon, Eugene, OR, USA.
| | - Emma L Eaton
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | | | - Rachel Kim
- The Baker Center for Children and Families, Boston, MA, USA
| | - Dan M Cheron
- The Baker Center for Children and Families, Boston, MA, USA
| | - Alayna L Park
- Department of Psychology, University of Oregon, Eugene, OR, USA
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Esposito G, Cuomo F, Di Maro A, Passeggia R. The assessment of therapist responsiveness in psychotherapy research: a systematic review. RESEARCH IN PSYCHOTHERAPY (MILANO) 2024; 27. [PMID: 38904610 DOI: 10.4081/ripppo.2024.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/13/2024] [Indexed: 06/22/2024]
Abstract
Therapist responsiveness is an emerging construct in psychotherapy research that still lacks a clear definition and, consequently, a unique operationalization. Indeed, there is a great overlap between therapist responsiveness and other variables, such as attunement, flexibility, and empathy. This overlap inevitably hinders the assessment of the therapist's responsiveness, although it is crucial for the effectiveness of the treatments. Therefore, the current systematic review aims at exploring the different methodologies of measurement and analysis of therapist responsiveness, including both direct and indirect instruments. The results confirmed difficulties and divergences in the operationalization of the construct, as shown by the great heterogeneity found in the choice and use of the tools. Furthermore, this review provides guidance for future research, clinical practice, and training of therapists.
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Affiliation(s)
| | | | - Angela Di Maro
- Department of Humanities, University of Naples Federico II.
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Youn SJ, Boswell JF, Douglas S, Harris BA, Aajmain S, Arnold KT, Creed TA, Gutner CA, Orengo-Aguayo R, Oswald JM, Stirman SW. Implementation Science and Practice-Oriented Research: Convergence and Complementarity. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:336-347. [PMID: 37646966 DOI: 10.1007/s10488-023-01296-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
Implementation science is the scientific study of methods to promote the uptake of research findings and other evidence-based practices in routine care, with the goal of improving the quality and effectiveness of health services (Bauer et al., 2015). In addition to this common goal, practice-oriented psychotherapy research (and researchers) and implementation science (and scientists) share a common focus on the people and the places where treatment happens. Thus, there exists strong potential for combining these two approaches. In this article, we provide a primer on implementation science for psychotherapy researchers and highlight important areas and examples of convergence and complementarity between implementation science and practice-oriented psychotherapy research. Specifically, we (a) define and describe the core features of implementation science; (b) discuss similarities and areas of complementarity between implementation science and practice-oriented psychotherapy research; (c) discuss a case example that exemplifies the integration of implementation science and practice-oriented research; and (d) propose directions for future research and collaborations that leverage both implementation science and practice-oriented research.
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Affiliation(s)
- Soo Jeong Youn
- Reliant Medical Group, OptumCare, Harvard Medical School, Worcester, MA, USA.
| | - James F Boswell
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Susan Douglas
- Department of Leadership, Policy and Organizations, Vanderbilt University, Nashville, TN, USA
| | - Bethany A Harris
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Syed Aajmain
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Kimberly T Arnold
- Whole Health Equity Lab, Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Torrey A Creed
- Penn Collaborative for CBT and Implementation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Cassidy A Gutner
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Rosaura Orengo-Aguayo
- Medical University of South Carolina (MUSC), National Crime Victims Research & Treatment Center, Charleston, SC, USA
| | | | - Shannon Wiltsey Stirman
- Dissemination and Training Division, National Center for PTSD, VA Palo Alto Healthcare System, Department of Psychiatry and Behavioral Sciences, Stanford University, Menlo Park, CA, USA
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McLeod BD, Violante S, Ross E, Weihl A, Kaur N, Southam-Gerow MA, Jones HA, Weisz JR, Chorpita BF. The Content of Usual Clinical Care for Youth with Primary Anxiety Problems. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01378-y. [PMID: 38635134 DOI: 10.1007/s10488-024-01378-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
The current study was designed to describe usual clinical care for youth with primary anxiety problems in community mental health centers. The observer-rated Therapy Process Observational Coding System for Child Psychotherapy - Revised Strategies scale (TPOCS-RS), designed to assess therapeutic techniques from five theory-based domains, was used to code sessions (N = 403) from the usual clinical care group of two randomized effectiveness trials: (a) Youth Anxiety Study (YAS) with 21 youth (M age = 10.44 years, SD = 1.91; 49.2% Latinx; 46.6%, 53.4% male) and 16 clinicians (77.5% female; 43.8% White), and (b) Child STEPS Multisite Trial with 17 youth (M age = 10.00 years, SD = 1.87; 58.8% male; 41.2% White) and 13 clinicians (M age = 40.00 years; SD = 9.18; 76.9% female; 61.5% White). The average number of TPOCS-RS items observed per treatment session was more than 10, and multiple techniques were used together in each session. All TPOCS-RS items were observed at least once throughout a clinical case, and most items reoccurred (i.e., observed in two or more sessions). The dosage of TPOCS-RS in all items was below 5 on a 7-point scale. In conclusion, clinicians in both usual care samples used a wide range of techniques from several theory-based domains at a low to medium dose. However, the type and dosage of the techniques used did vary across the two samples.
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Affiliation(s)
- Bryce D McLeod
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin Street, PO Box 842018, Richmond, VA, 23284-2018, USA.
| | - Stephanie Violante
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Erica Ross
- School of Education, Virginia Commonwealth University, Richmond, USA
| | - Alexys Weihl
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin Street, PO Box 842018, Richmond, VA, 23284-2018, USA
| | - Navneet Kaur
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin Street, PO Box 842018, Richmond, VA, 23284-2018, USA
| | - Michael A Southam-Gerow
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin Street, PO Box 842018, Richmond, VA, 23284-2018, USA
| | - Heather A Jones
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin Street, PO Box 842018, Richmond, VA, 23284-2018, USA
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, USA
| | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, USA
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Esposito G, Di Maro A, Passeggia R. The relationship between treatment integrity and outcome in group psychotherapy: A systematic review. Clin Psychol Psychother 2024. [PMID: 38217388 DOI: 10.1002/cpp.2952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/15/2024]
Abstract
Treatment integrity is defined as the extent to which the treatment has been implemented according to a specific theoretical model. It consists of two components: adherence, that is, the degree to which the therapist implements the techniques prescribed by the theoretical model, and competence, that is, the degree to which the therapist skilfully and appropriately implements the techniques prescribed by the model. Recently, the issue of integrity is gaining increasing importance in psychotherapy research, especially in an attempt to clarify its role in influencing the effectiveness of treatments. However, most studies focus on the individual setting. Therefore, this systematic review aims at investigating the relationship between integrity and outcome in group clinical treatments. Results highlighted a positive relationship between group treatment integrity and outcome. Moreover, this review provided insights for implications for research, clinical practice, and training of therapists, identifying questions that still need to be answered and tracing possible future research directions.
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Affiliation(s)
- Giovanna Esposito
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | - Angela Di Maro
- Department of Humanities, University of Naples Federico II, Naples, Italy
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Sayer NA, Wiltsey Stirman S, Rosen CS, Kehle-Forbes S, Spoont MR, Eftekhari A, Chard KM, Kaplan A, Nelson DB. The role of therapy delivery and clinic organizational factors in explaining therapist effects for trauma-focused psychotherapies in the Veterans Health Administration. J Consult Clin Psychol 2023; 91:665-679. [PMID: 37668578 PMCID: PMC10592522 DOI: 10.1037/ccp0000832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVE This study estimated the size of therapist effects (TEs) for dropout and clinical effectiveness of two trauma-focused psychotherapies (TFPs) and evaluated whether therapy delivery and clinic organizational factors explained observed TEs. METHOD Participants were 180 therapists (54.4% psychologists, 42.2% social workers) from 137 Veterans Health Administration facilities and 1,735 patients (24.7% women; 27.2% people of color) who completed at least two TFP sessions. Outcomes were dropout (< 8 TFP sessions) and for a subsample (n = 1,273), clinically meaningful improvement and recovery based on posttraumatic stress disorder checklist for DSM-5 (PCL-5) scores. Therapist-level predictors were ascertained through survey, manual chart review, and administrative data. Multilevel models estimated TEs. RESULTS Over half (51.2%) of patients dropped out and those who dropped out were less likely to meet criteria for clinically meaningful improvement or recovery (ps < .001). Adjusting for case-mix and TFP type, therapists accounted for 5.812% (p < .001) of the unexplained variance in dropout. The average dropout rate for the 45 therapists in the top performing quartile was 27.0%, while the average dropout rate for the 45 therapists in the bottom performing quartile was 78.8%. Variation between therapists was reduced to 2.031% (p = .140) when therapists' mean of days between sessions, adherence, implementation climate, and caseload were added to multilevel models. TEs were nonsignificant for clinically meaningful improvement and recovery. CONCLUSIONS Interventions targeting therapy delivery and clinic organization have the potential to reduce variation between therapists in TFP dropout, so that more patients stay engaged long enough to experience clinical benefit. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Nina A Sayer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System
| | - Shannon Wiltsey Stirman
- National Center for Posttraumatic Stress Disorder, Dissemination and Training Division, VA Palo Alto Health Care System
| | - Craig S Rosen
- National Center for Posttraumatic Stress Disorder, Dissemination and Training Division, VA Palo Alto Health Care System
| | - Shannon Kehle-Forbes
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System
| | - Michele R Spoont
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System
| | - Afsoon Eftekhari
- National Center for Posttraumatic Stress Disorder, Dissemination and Training Division, VA Palo Alto Health Care System
| | - Kathleen M Chard
- Posttraumatic Stress Disorder and Anxiety Disorder Division, Cincinnati Veterans Affairs Medical Center
| | - Adam Kaplan
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System
| | - David B Nelson
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System
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Kuroda Y, Fujita K, Sugimoto T, Uchida K, Shimazu T, Saito J, Arai H, Sakurai T. Feasibility of a community-adapted multi-domain intervention for dementia prevention among older adults: a research protocol. Arch Public Health 2023; 81:191. [PMID: 37907936 PMCID: PMC10617126 DOI: 10.1186/s13690-023-01205-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/20/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Multi-domain interventions effectively prevent dementia in clinical settings; however, their efficacy within local communities is unclear. This study assesses the feasibility of an adapted multi-domain intervention for dementia prevention in community-dwelling older adults. METHODS The single-arm trial enrolls 60 participants from two Obu City communities, Japan. PRIMARY OUTCOME participant retention in the adapted multi-domain intervention; secondary outcomes: health and implementation outcomes. Over 12 months, a team of researchers and public health nurse oversees the study in the first half, gradually shifting the management to public health nurses in the second half. Using the Framework for Reporting Adaptations and Modifications-Enhanced, the clinical programme is adjusted for the local community. It includes a 60-minute exercise and 30-minute group sessions, targeting lifestyle, diet, and social participation. DISCUSSION This pioneer study evaluates the feasibility of an adapted intervention programme for dementia prevention in a community setting. Challenges in disseminating dementia prevention programmes warrant further investigation into effective implementation as well as strategies and methods to appeal to the target population. Upon confirming this programme's feasibility, future studies can further evaluate its broader effectiveness. TRIAL REGISTRATION The protocol is registered with the Clinical Trials Registry (UMIN-CTR) of the University Hospital's Medical Information Network, under registration number UMIN000050581.
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Affiliation(s)
- Yujiro Kuroda
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, 474-8511, Aichi, Japan.
| | - Kosuke Fujita
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, 474-8511, Aichi, Japan
| | - Taiki Sugimoto
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, 474-8511, Aichi, Japan
| | - Kazuaki Uchida
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, 474-8511, Aichi, Japan
| | - Taichi Shimazu
- Division of Behavioural Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Junko Saito
- Division of Behavioural Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Hidenori Arai
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, 474-8511, Aichi, Japan
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Takashi Sakurai
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, 474-8511, Aichi, Japan
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Steil R, Weiss J, Müller-Engelmann M, Dittmann C, Priebe K, Kleindienst N, Fydrich T, Stangier U. Is adherence to dialectic behaviour therapy for post-traumatic stress disorder (PTSD) and cognitive processing therapy related to treatment outcome in PTSD after childhood abuse? Eur J Psychotraumatol 2023; 14:2260293. [PMID: 37860858 PMCID: PMC10591525 DOI: 10.1080/20008066.2023.2260293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 07/04/2023] [Indexed: 10/21/2023] Open
Abstract
Background: Literature on the association between therapist adherence and treatment success in the treatment of post-traumatic stress disorder (PTSD) is scarce, and the results are mixed.Objective: To examine the relationship between therapist adherence to dialectical behaviour therapy for PTSD (DBT-PTSD) and cognitive processing therapy (CPT) on treatment outcome in women with PTSD and emotion regulation difficulties after interpersonal childhood abuse.Method: Videotaped therapy sessions from 160 female participants of a large randomized controlled trial [Bohus, M., Kleindienst, N., Hahn, C., Müller-Engelmann, M., Ludäscher, P., Steil, R., Fydrich, T., Kuehner, C., Resick, P. A., Stiglmayr, C., Schmahl, C., & Priebe, K. (2020). Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) compared with cognitive processing therapy (CPT) in complex presentations of PTSD in women survivors of childhood abuse. JAMA Psychiatry, 77(12), 1235. jamapsychiatry.2020.2148] were rated. Adherence to CPT and DBT-PTSD was assessed using two specifically developed rating scales.Results: Higher therapist adherence was associated with a greater reduction of clinician-rated PTSD symptom severity. This effect was more pronounced in the CPT group than in the DBT-PTSD group. Adherence was also related to a greater reduction of self-rated PTSD symptoms, borderline symptoms, and dissociation intensity.Conclusion: Our results indicate that higher therapist adherence can lead to better treatment outcomes in PTSD treatments, especially in CPT.
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Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Judith Weiss
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
- Department of Psychology, Medical School Hamburg, Faculty Human Sciences, Hamburg, Germany
| | - Clara Dittmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Kathlen Priebe
- Department of Psychology, Faculty of Life Sciences, Humboldt-University of Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Thomas Fydrich
- Department of Psychology, Faculty of Life Sciences, Humboldt-University of Berlin, Berlin, Germany
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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13
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Sripada RK, Peterson CL, Dziak JJ, Nahum-Shani I, Roberge EM, Martinson AA, Porter K, Grau P, Curtis D, McElroy S, Bryant S, Gracy I, Pryor C, Walters HM, Austin K, Ehlinger C, Sayer N, Wiltsey-Stirman S, Chard K. Using the multiphase optimization strategy to adapt cognitive processing therapy (CPT MOST): study protocol for a randomized controlled factorial experiment. Trials 2023; 24:676. [PMID: 37858262 PMCID: PMC10588087 DOI: 10.1186/s13063-023-07669-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Approximately ten percent of US military veterans suffer from posttraumatic stress disorder (PTSD). Cognitive processing therapy (CPT) is a highly effective, evidence-based, first-line treatment for PTSD that has been widely adopted by the Department of Veterans Affairs (VA). CPT consists of discrete therapeutic components delivered across 12 sessions, but most veterans (up to 70%) never reach completion, and those who discontinue therapy receive only four sessions on average. Unfortunately, veterans who drop out prematurely may never receive the most effective components of CPT. Thus, there is an urgent need to use empirical approaches to identify the most effective components of CPT so CPT can be adapted into a briefer format. METHODS The multiphase optimization strategy (MOST) is an innovative, engineering-inspired framework that uses an optimization trial to assess the performance of individual intervention components within a multicomponent intervention such as CPT. Here we use a fractional factorial optimization trial to identify and retain the most effective intervention components to form a refined, abbreviated CPT intervention package. Specifically, we used a 16-condition fractional factorial experiment with 270 veterans (N = 270) at three VA Medical Centers to test the effectiveness of each of the five CPT components and each two-way interaction between components. This factorial design will identify which CPT components contribute meaningfully to a reduction in PTSD symptoms, as measured by PTSD symptom reduction on the Clinician-Administered PTSD Scale for DSM-5, across 6 months of follow-up. It will also identify mediators and moderators of component effectiveness. DISCUSSION There is an urgent need to adapt CPT into a briefer format using empirical approaches to identify its most effective components. A brief format of CPT may reduce attrition and improve efficiency, enabling providers to treat more patients with PTSD. The refined intervention package will be evaluated in a future large-scale, fully-powered effectiveness trial. Pending demonstration of effectiveness, the refined intervention can be disseminated through the VA CPT training program. TRIAL REGISTRATION ClinicalTrials.gov NCT05220137. Registration date: January 21, 2022.
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Affiliation(s)
- Rebecca K Sripada
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Department of Psychiatry, University of Michigan, Ann Arbor, USA.
| | - Cassaundra L Peterson
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - John J Dziak
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, USA
| | - Inbal Nahum-Shani
- University of Michigan Institute for Social Research, Ann Arbor, USA
| | - Erika M Roberge
- VA Salt Lake City Health Care System, University of Utah School of Medicine, Salt Lake City, USA
| | | | | | - Peter Grau
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | - Diana Curtis
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | | | - Sarah Bryant
- VA Salt Lake City Health Care System, Salt Lake City, USA
| | - Isabel Gracy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Cosette Pryor
- VA Salt Lake City Health Care System, Salt Lake City, USA
| | - Heather M Walters
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Karen Austin
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | | | - Nina Sayer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, USA
| | | | - Kathleen Chard
- Cincinnati VA Medical Center, University of Cincinnati, Cincinnati, USA
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Motamedi M, Lau AS, Byeon YV, Yu SH, Brookman-Frazee L. Supporting Emotionally Exhausted Community Mental Health Therapists in Appropriately Adapting EBPs for Children and Adolescents. J Behav Health Serv Res 2023; 50:468-485. [PMID: 37430134 DOI: 10.1007/s11414-023-09844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/12/2023]
Abstract
Evidence-based practices (EBPs) are often adapted during community implementation to improve EBP fit for clients and the service context. Augmenting EBPs with additional dosing and content may improve fit. However, reducing EBP content can reduce EBP effectiveness. Using multilevel regression models, this study examined whether supportive program climate and program-furnished EBP-specific implementation strategies (e.g., materials, ongoing training, in-house experts) are associated with augmenting and reducing adaptations, and whether therapist emotional exhaustion moderated these associations. Data were collected from surveys completed by 439 therapists from 102 programs 9 years after a system-driven EBP implementation initiative. Supportive program climate was associated with more augmenting adaptations. Emotional exhaustion was a significant moderator. When organizations used more EBP-specific implementation strategies, more emotionally exhausted therapists reduced EBPs less and less emotionally exhausted therapists augmented EBPs more. Findings provide guidance on how organizations can support appropriate EBP adaptations in spite of therapist emotional exhaustion.
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Affiliation(s)
- Mojdeh Motamedi
- University of California San Diego, La Jolla, USA.
- Child and Adolescent Services Research Center, San Diego, USA.
| | - Anna S Lau
- University of California Los Angeles, Los Angeles, USA
| | | | | | - Lauren Brookman-Frazee
- University of California San Diego, La Jolla, USA
- Child and Adolescent Services Research Center, San Diego, USA
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15
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Steil R, Weiss J, Müller-Engelmann M, Dittmann C, Priebe K, Kleindienst N, Fydrich T, Stangier U. Does treatment specific-, disorder specific- or general therapeutic competence predict symptom reduction in posttraumatic stress disorder? Eur J Psychotraumatol 2023; 14:2257434. [PMID: 37753639 PMCID: PMC10538459 DOI: 10.1080/20008066.2023.2257434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/13/2023] [Indexed: 09/28/2023] Open
Abstract
Background: Literature on the association between therapist competence and treatment success in posttraumatic stress disorder (PTSD) treatments is scarce and results are mixed.Aims/Objective: The relationship between different types of therapeutic competence, therapeutic alliance, and PTSD symptom reduction in patients treated with Dialectical Behaviour Therapy for PTSD (DBT-PTSD) or Cognitive Processing Therapy (CPT) was assessed. Competence types were PTSD-specific competence, treatment specific competence, and general competence in cognitive behaviour therapy (CBT).Method: Videotaped therapy sessions from N = 160 women with PTSD and emotion regulation difficulties after child abuse participating in a large randomised controlled trial (Bohus et al., 2020) were rated. Three therapeutic competence-types were assessed using specifically developed rating scales. Alliance was assessed via patient ratings with the Helping Alliance Questionnaire (HAQ). PTSD symptoms were assessed at pre- and post-treatment via clinician rating with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and via self-rating with the PTSD-Checklist for DSM-5 (PCL-5).Results: No significant association between competence and clinician or self-rated PTSD symptoms was found. PTSD specific competence predicted clinician rated PTSD symptom severity on a trend level. Alliance predicted both clinician and self-rated PTSD symptom reduction.Conclusion: Our results provide a starting point for future research on different competence types and their association with PTSD treatment gains. Therapists were highly trained and received weekly supervision, hence a restricted competence range is a possible explanation for non-existing associations between competence and PTSD symptom reduction in our sample. More research in naturalistic settings, such as dissemination studies, is needed.
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Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Judith Weiss
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
- Faculty Human Sciences, Department Psychology, Medical School Hamburg, Germany
| | - Clara Dittmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Kathlen Priebe
- Department of Psychology, Faculty of Life Sciences, Humboldt-University of Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Thomas Fydrich
- Department of Psychology, Faculty of Life Sciences, Humboldt-University of Berlin, Berlin, Germany
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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16
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Goldschmidt AB, Tortolani CC, Accurso EC, Dunbar EMP, Egbert AH, Donaldson D, Donaldson AA. Adapting family-based treatment for adolescent anorexia nervosa delivered in the home: A novel approach for improving access to care and generalizability of skill acquisition. J Eat Disord 2023; 11:130. [PMID: 37543601 PMCID: PMC10403819 DOI: 10.1186/s40337-023-00850-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious mental illness associated with high rates of morbidity and mortality. Family-based treatment (FBT) is a well-established treatment for adolescent AN, yet it is underutilized in community settings and is unavailable to many families, particularly those from lower income and racial and ethnic minority backgrounds. Furthermore, some families do not respond optimally to FBT, possibly because of challenges translating skills acquired in office-based treatment settings to naturalistic settings. Home-based treatment could reduce barriers to access and enhance generalization of newly learned treatment skills. Home-based models demonstrate initial feasibility, acceptability, and efficacy for adolescent AN, however, FBT principles have yet to be applied as a stand-alone intervention in a home-based level of care. This paper describes the rationale for and process of adapting FBT principles/interventions to improve fit within a home-based model delivered in the context of community mental health, and discusses potential strengths and opportunities associated with this approach. RESULTS Adaptations were made through consultation with collaborating community agencies and were guided by the complex interventions framework. The primary modifications included: (1) altered dose; (2) multiple family meals; (3) additional support for meal preparation and supervision; (4) clinician attendance at medical appointments; (5) cultural adaptation; and (6) introduction of distress tolerance and emotion regulation skills. CONCLUSIONS Implementing FBT in the home may present one promising and novel approach to enhance engagement and treatment outcomes for adolescents with restrictive eating disorders, particularly those who are underserved, but evaluation of efficacy/effectiveness is needed.
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Affiliation(s)
- Andrea B Goldschmidt
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Christina C Tortolani
- Department of Counseling, Educational Leadership, and School Psychology, Rhode Island College, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
| | - Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | | | - Amy H Egbert
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
- Department of Psychological Sciences, University of Connecticut, Connecticut, Storz, USA
| | - Deidre Donaldson
- Department of Family Medicine, Warren Alpert Medical School of Brown University/Gateway Healthcare, Providence, RI, USA
| | - Abigail A Donaldson
- Department of Pediatrics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
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17
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Steil R, Weiss J, Renneberg B, Gutermann J, Rosner R. Effect of therapeutic competence, adherence, and alliance on treatment outcome in youth with PTSD treated with developmentally adapted cognitive processing therapy. CHILD ABUSE & NEGLECT 2023; 141:106221. [PMID: 37178528 DOI: 10.1016/j.chiabu.2023.106221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/06/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Developmentally adapted cognitive processing therapy (D-CPT) is an effective treatment for posttraumatic stress disorder (PTSD) in adolescents and young adults. It is unclear if therapeutic adherence and competence in D-CPT are associated with higher PTSD treatment gains. OBJECTIVE To assess if higher therapeutic adherence and competence in D-CPT are associated with higher symptom reduction of PTSD in adolescents and young adults, while controlling for therapeutic alliance. PARTICIPANTS AND SETTING Participants were 38 patients (aged 14-21 years; M = 17.61 years, SD = 2.42 years) of a multicenter randomized controlled trial in which the efficacy of D-CPT was compared to a waitlist with treatment advice. METHODS Videotaped therapy sessions were rated using validated ratings scales to assess adherence and competence. Therapeutic alliance was assessed via weekly patient ratings. We used hierarchical linear modelling to assess the relationship of adherence and competence on PTSD symptoms being measured by both clinician and patient while controlling for alliance. RESULTS Neither adherence nor competence were related to treatment outcomes in clinician or patient rated PTSD symptom severity. Higher alliance was associated with a lower symptom severity at 12 months posttreatment in both clinician and patient rated PTSD symptoms. CONCLUSIONS In this study of young adults with PTSD, who were treated with D-CPT by well-trained therapists, therapeutic adherence and competence were not related to treatment outcome. This might be explained by a lack of range in therapist adherence and competence. Therapeutic alliance had a positive effect on PTSD symptom severity.
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Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Judith Weiss
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Babette Renneberg
- Department of Clinical Psychology and Psychotherapy, Freie Universitaet Berlin, Berlin, Germany
| | - Jana Gutermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
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18
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Craig SL, Pascoe RV, Iacono G, Pang N, Pearson A. Assessing the Fidelity of an Affirmative Cognitive Behavioral Group Intervention. RESEARCH ON SOCIAL WORK PRACTICE 2023; 33:375-389. [PMID: 37034184 PMCID: PMC10074758 DOI: 10.1177/10497315221110865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE Support implementation fidelity in intervention research with lesbian, gay, bisexual, transgender, queer, and sexual and gender diverse (LGBTQ+) populations, this study explores the systematic development of a fidelity process for AFFIRM, an evidence-based, affirmative cognitive behavioral therapy group intervention for LGBTQ+ youth and adults. METHOD As part of a clinical trial, the AFFIRM fidelity checklist was designed to assess clinician adherence. A total of 151 audio-recorded group sessions were coded by four trained raters. RESULTS Adherence was high with a mean fidelity score of 84.13 (SD = 12.50). Inter-rater reliability was 81%, suggesting substantial agreement. Qualitative thematic analysis of low-rated sessions identified deviations from the manual and difficulties in group facilitation, while high-rated sessions specified affirmative and effective clinical responses. DISCUSSION Findings were integrated into clinical training and coaching. The fidelity process provides insights into the challenges of implementing social work interventions effectively with LGBTQ+ populations in community settings.
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Affiliation(s)
- Shelley L. Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Rachael V. Pascoe
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Gio Iacono
- School of Social Work, University of Connecticut, Hartford, CT, USA
| | - Nelson Pang
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Ali Pearson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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19
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Powers KE, das Nair R, Phillips J, Farrin A, Radford KA. Exploring the Association between Individual-Level Attributes and Fidelity to a Vocational Rehabilitation Intervention within a Randomised Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4694. [PMID: 36981601 PMCID: PMC10048688 DOI: 10.3390/ijerph20064694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Understanding what attributes or characteristics of those delivering interventions affect intervention fidelity and patient outcomes is important for contextualising intervention effectiveness. It may also inform implementation of interventions in future research and clinical practice. This study aimed to explore the relationships between attributes of Occupational Therapists (OTs), their faithful delivery of an early stroke specialist vocational rehabilitation intervention (ESSVR), and stroke survivor return-to-work (RTW) outcomes. Thirty-nine OTs were surveyed about their experience and knowledge of stroke and vocational rehabilitation and were trained to deliver ESSVR. ESSVR was delivered across 16 sites in England and Wales between February 2018 and November 2021. OTs received monthly mentoring to support ESSVR delivery. The amount of mentoring each OT received was recorded in OT mentoring records. Fidelity was assessed using an intervention component checklist completed using retrospective case review of one randomly selected participant per OT. Linear and logistic regression analyses explored relationships between OT attributes, fidelity, and stroke survivor RTW outcome. Fidelity scores ranged from 30.8 to 100% (Mean: 78.8%, SD: 19.2%). Only OT engagement in mentoring was significantly associated with fidelity (b = 0.29, 95% CI = 0.05-0.53, p < 0.05). Increased fidelity (OR = 1.06, 95% CI = 1.01-1.1, p = 0.01) and increasing years of stroke rehabilitation experience (OR = 1.17, 95% CI = 1.02-1.35) was significantly associated with positive stroke survivor RTW outcomes. Findings of this study suggest that mentoring OTs may increase fidelity of delivery of ESSVR, which may also be associated with positive stroke survivor return-to-work outcomes. The results also suggest that OTs with more experience of stroke rehabilitation may be able to support stroke survivors to RTW more effectively. Upskilling OTs to deliver complex interventions, such as ESSVR, in clinical trials may require mentoring support in addition to training to ensure fidelity.
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Affiliation(s)
- Katie E. Powers
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Roshan das Nair
- Health Division, SINTEF, 7465 Trondheim, Norway
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Julie Phillips
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9JT, UK
| | - Kathryn A. Radford
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
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20
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McLeod BD, Sutherland KS, Conroy MA, Lyon AR, Chapman JE, Granger KL, Saldana L. Study Protocol: Multi-level Determinants of Implementation and Sustainment in the Education Sector. JOURNAL OF EMOTIONAL AND BEHAVIORAL DISORDERS 2023; 31:27-40. [PMID: 36874907 PMCID: PMC9983801 DOI: 10.1177/10634266221090160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Evidence-based programs (EBPs) delivered in elementary schools show great promise in reducing risk for emotional and behavioral disorders (EBDs). However, efforts to sustain EBPs in school face barriers. Improving EBP sustainment thus represents a priority, but little research exists to inform the development of sustainment strategies. To address this gap, the Sustaining Evidenced-Based Innovations through Multi-level Implementation Constructs (SEISMIC) project will: (a) Determine if malleable individual, intervention, and organizational factors predict EBP treatment fidelity and modifications during implementation, sustainment, or both; (b) Assess the impact of EBP fidelity and modifications on child outcomes during implementation and sustainment; and (c) Explore the mechanisms through which individual, intervention, and organizational factors influence sustainment outcomes. This protocol paper describes SEISMIC, which builds upon a federally-funded RCT evaluating BEST in CLASS, a teacher-delivered program for K-3rd grade children at risk for EBDs. The sample will include 96 teachers, 384 children, and 12 elementary schools. A multi-level, interrupted time series design will be used to examine the relationship between baseline factors, treatment fidelity, modifications, and child outcomes, followed by a mixed-method approach to elucidate the mechanisms that influence sustainment outcomes. Findings will be used to create a strategy to improve EBP sustainment in schools.
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21
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Giusto A, Friis-Healy EA, Kaiser BN, Ayuku D, Rono W, Puffer ES. Mechanisms of change for a family intervention in Kenya: An Integrated Clinical and Implementation Mapping approach. Behav Res Ther 2022; 159:104219. [PMID: 36283239 PMCID: PMC10155602 DOI: 10.1016/j.brat.2022.104219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/02/2022] [Accepted: 10/14/2022] [Indexed: 12/14/2022]
Abstract
To increase cultural relevance and maximize access for historically underserved populations, there is a need to explore mechanisms underlying treatment outcomes during piloting. We developed a mixed-method approach, Integrated Clinical and Implementation Mapping (ICIM), to explore clinical and implementation mechanisms to inform improvements in content and delivery. We applied ICIM in a pilot of Tuko Pamoja, a lay counselor-delivered family intervention in Kenya (10 families with adolescents ages 12-17). ICIM is a 3-phase process to triangulate data sources to analyze how and why change occurs within individual cases and across cases. We synthesized data from session and supervision transcripts, fidelity and clinical skills ratings, surveys, and interviews. Outputs included a comprehensive narrative and visual map depicting how content and implementation factors influenced change. For Tuko Pamoja, ICIM results showed common presenting problems, including financial strain and caregivers' distress, triggering negative interactions and adolescent distress. ICIM demonstrated that active treatment ingredients included communication skills and facilitated, prescribed time together. Families improved communication, empathy, and hope, facilitated improved family functioning and mental health. Key implementation mechanisms included provider clinical competencies, alliance-building, treatment-aligned adaptations, and consistent attendance. Results guided manual and training refinements and generated hypotheses about mechanisms to test in larger trials.
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Affiliation(s)
- Ali Giusto
- New York State Psychiatric Institute, Columbia University, Department of Psychiatry, New York, NY, 10032, USA; Duke Global Health Institute, Durham, NC, USA.
| | - Elsa A Friis-Healy
- Duke Global Health Institute, Durham, NC, USA; Department of Psychiatry Duke University School of Medicine, Durham, NC, USA.
| | - Bonnie N Kaiser
- Duke Global Health Institute, Durham, NC, USA; University of California San Diego, Anthropology Department and Global Health Program, La Jolla, CA, USA.
| | - David Ayuku
- Moi University, Academic Highway, Eldoret, Usain Gishu County, Kenya.
| | - Wilter Rono
- Moi Teaching & Referral Hospital, Eldoret, Rift Valley, Kenya.
| | - Eve S Puffer
- Duke Global Health Institute, Durham, NC, USA; Department of Neuroscience and Psychology, Duke University, Durham, NC, USA.
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22
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Wiltsey Stirman S, La Bash H, Nelson D, Orazem R, Klein A, Sayer NA. Assessment of modifications to evidence-based psychotherapies using administrative and chart note data from the US department of veterans affairs health care system. Front Public Health 2022; 10:984505. [PMID: 36457312 PMCID: PMC9705357 DOI: 10.3389/fpubh.2022.984505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background The US Department of Veterans Affairs (VA) has over 15 years of experience in delivery of evidence-based psychotherapies (EBPs). This paper describes strategies for using clinical documentation and administrative data to understand adherence and modifications to EBPs for Posttraumatic Stress Disorder (PTSD). Methods This study focused on two EBPs for PTSD, Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). The sample included VA therapists from across the US who provided CPT and PE and the patients they treated over a 1-year period. The data sources for this study were templated EBP chart notes and VA administrative data. We used a manual review of note content and administrative data rules to code therapy adherence and modifications in 7,297 EBP sessions for 1,257 patients seen by 182 therapists. Two trained coders rated each therapy note and resolved discrepancies through consensus. To contextualize and explain variation in adherence and modifications, we conducted brief 30-45-min semi-structured interviews with a purposive subsample of these therapists (n = 32). Findings Combining manual chart review and administrative data allowed for identification of 11 types of modifications. Raters disagreed on adherence for 30% of notes. The disagreement stemmed from the presence of therapy modifications that were not clearly documented, necessitating the development of decision rules and strategies for modification coding. Both therapists and patients contributed to the variance in the extent to which different modifications occurred. Therapist interviews demonstrated therapist awareness of modifying the protocols in the ways identified through chart review. Conclusion Healthcare systems can use data collected as part of routine care to understand how and when EBPs are modified but need to develop scalable strategies to document adaptations and modifications to EBPs in routine care.
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Affiliation(s)
- Shannon Wiltsey Stirman
- National Center for PTSD, VA Palo Alto Healthcare System, Menlo Park, CA, United States,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States,*Correspondence: Shannon Wiltsey Stirman
| | - Heidi La Bash
- National Center for PTSD, VA Palo Alto Healthcare System, Menlo Park, CA, United States
| | - David Nelson
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, United States,Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Robert Orazem
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, United States
| | - Abigail Klein
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, United States
| | - Nina A. Sayer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, United States,Department of Medicine and Psychiatry, University of Minnesota, Minneapolis, MN, United States
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23
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LoSavio ST, Holder N, Wells SY, Resick PA. Clinician Concerns About Cognitive Processing Therapy: A Review of the Evidence. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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24
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Williams NJ, Hugh ML, Cooney DJ, Worley JA, Locke J. Testing a Theory of Implementation Leadership and Climate Across Autism Evidence-Based Interventions of Varying Complexity. Behav Ther 2022; 53:900-912. [PMID: 35987547 PMCID: PMC9395730 DOI: 10.1016/j.beth.2022.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/21/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022]
Abstract
Prominent theories within the field of implementation science contend that organizational leaders can improve providers' fidelity to evidence-based practices (EBPs) by using focused implementation leadership behaviors that create an organizational climate for EBP implementation. However, this work has been criticized for overreliance on nonspecific, self-report fidelity measures and poor articulation of the boundary conditions that may attenuate leadership and climate's influence. This study tests the predictions of EBP implementation leadership and climate theory on observed fidelity to three school-based EBPs for autism that vary in complexity: pivotal response training (PRT), discrete trial training (DTT), and visual schedules (VS). Educators in kindergarten to third-grade autism support classrooms in 65 schools assessed their principals' EBP implementation leadership and school EBP implementation climate prior to the school year. Mid-school year, trained observers rated educator fidelity to all three interventions. Expert raters confirmed PRT was significantly more complex than DTT or VS using the Intervention Complexity Assessment Tool for Systematic Reviews. Linear regression analyses at the school level indicated principals' increased frequency of EBP implementation leadership predicted a higher school EBP implementation climate, which in turn predicted higher educator fidelity to PRT-however, there was no evidence of a relationship between implementation climate and fidelity to DTT or VS. Comparing principals whose EBP implementation leadership was ±1 SD from the mean, there was a significant indirect association of EBP implementation leadership with PRT fidelity through EBP implementation climate (d = 0.49, 95% CI [0.04, 0.93]). Strategies that target EBP implementation leadership and climate may support fidelity to complex behavioral interventions.
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25
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ELBARAZI A, BADARY OA, ELMAZAR MM, ELRASSAS H. Cognitive Processing Therapy Versus Medication for the Treatment of Comorbid Substance Use Disorder and Post-Traumatic Stress Disorder in Egyptian patients (Randomized Clinical Trial). JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES 2022. [DOI: 10.24193/jebp.2022.2.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
"Earlier research has established that posttraumatic stress disorder (PTSD) and substance use disorder (SUD) frequently coexist. Aims: Cognitive Processing Therapy was compared to Sertraline and a placebo in an RCT for treating patients with comorbid SUD and PTSD. Methods: 150 patients with SUD and PTSD were interviewed by clinicians and asked to fill out the Clinician-Administered PTSD Scale (CAPS-5), Posttraumatic Stress Disorder Checklist (PCL-5), Beck Depression Inventory (BDI-II), Timeline Follow Back Interview (TLFB), and Brief Addiction Monitor (BAM). Patients were randomly assigned to the following conditions: CPT (n=50), Sertraline (n=50), or Placebo (n=50). Pretreatment, posttreatment, six and, twelve-month follow-up assessments were conducted. Results: When compared to the sertraline group, CPT resulted in much higher reductions in CAPS scores at posttreatment assessment (d=0.93, p < .000). When compared to the control group, CPT considerably reduced PTSD symptoms (the effect size, d=1.9, p < .000). Sertraline resulted in many significant decreases in CAPS when compared to control groups (the effect size , d=1.11, p<.000). At posttreatment, SUD and depression severity were significantly reduced in both CPT and Sertraline groups. After six and twelve months of follow-up, these differences persisted. Conclusion: Comparatively to the control group, CPT and Sertraline significantly decreased PTSD, SUD, and depression."
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26
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Keefe JR, Hernandez S, Johanek C, Landy MSH, Sijercic I, Shnaider P, Wagner AC, Lane JEM, Monson CM, Stirman SW. Competence in Delivering Cognitive Processing Therapy and the Therapeutic Alliance Both Predict PTSD Symptom Outcomes. Behav Ther 2022; 53:763-775. [PMID: 35987537 DOI: 10.1016/j.beth.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/04/2021] [Accepted: 12/07/2021] [Indexed: 11/02/2022]
Abstract
Cognitive Processing Therapy (CPT) is efficacious in treating PTSD, but there remains a need to improve outcomes for individuals who do not fully respond to treatment. Differences between patient-therapist dyads in the fidelity (i.e., adherence and competence) of CPT delivery and the quality of the therapeutic relationship may partly explain differential levels of symptom improvement. Sessions were sampled from a randomized trial comparing different consultation conditions in training therapists new to CPT. Among 69 patients, one session from Sessions 1-3 and one session from Sessions 4-7 were reliably rated for adherence and competence using the CPT Therapist Adherence and Competence Scale, and for therapeutic alliance using the Working Alliance Inventory-Observer scale. Mixed models, including detrending using a fixed effect of session, predicted self-reported Posttraumatic Stress Disorder Checklist (PCL-IV) scores in one session using process scores from the previous session. The statistical interaction between fidelity and alliance scores to predict outcome was also examined. Alliance had significant, positive correlations (rs = 0.18-0.21) with same-session adherence and competence. Higher competence scores and higher therapeutic alliance scores in one session were independently associated with lower PCL-IV scores in the subsequent session. Adherence scores, which tended to be very high with relatively less variability, did not significantly relate to subsequent-session PCL-IV scores. Competence significantly interacted with alliance, such that sessions high in both competence and alliance predicted especially lower subsequent-session PCL-IV scores. A strong therapeutic alliance may have a synergistic, salutary effect with the competent delivery of CPT.
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Affiliation(s)
| | | | | | | | | | | | | | - Jeanine E M Lane
- Ryerson University, Toronto; Ontario Shores Center for Mental Health Sciences, Whitby, Ontario
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27
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Wiltsey Stirman S. Implementing Evidence-Based Mental-Health Treatments: Attending to Training, Fidelity, Adaptation, and Context. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2022. [DOI: 10.1177/09637214221109601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article provides a very high-level overview of some key considerations in the field of implementation science as it relates to clinical psychology. The article reviews recent findings regarding treatment fidelity, adaptation of treatments, and clinical outcomes. It then details some recent findings on training therapists to provide evidence-based therapies as they were designed to be delivered, with sufficient skill and adaptations if needed to ensure better fit for clients who receive treatments in different treatment settings. Finally, the article considers implications for implementing and sustaining new treatments and supporting their fidelity and adaptation, as well as key directions for future research.
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Affiliation(s)
- Shannon Wiltsey Stirman
- Dissemination and Training Division, National Center for PTSD, VA Palo Alto Healthcare System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University
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28
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Jacobs S, Muhlheim L, Rienecke RD. Phase 2 of family-based treatment: an exploratory assessment of clinician practices. Eat Weight Disord 2022; 27:2137-2142. [PMID: 35076903 DOI: 10.1007/s40519-022-01360-3] [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] [Received: 10/12/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE In manualized family-based treatment (FBT) for eating disorders, phase 1 of the 3-phase treatment-during which parents are put in control of eating-related issues-is perhaps the most critical phase, and is comprehensively addressed in the manual. Phase 2, during which control over eating is gradually returned to the patient, is more variable and the manual dedicates less space to this phase. The purpose of the current exploratory study was to assess Phase 2 practices of clinicians providing FBT and to compare these practices to the guidance offered in the manual. METHODS In the current study, a survey assessing Phase 2 practices was sent to clinicians. Twenty-seven providers responded. Two providers reported that they did not provide FBT in an outpatient setting. One reported not currently providing outpatient FBT but had in the past. The remaining providers were currently providing FBT in an outpatient setting. RESULTS No items addressing the core interventions of Phase 2, including encouraging age-appropriate independent eating, were endorsed by 100% of respondents as being addressed 100% of the time in Phase 2. CONCLUSION Responses reflected some adherence to the manual, along with examples of therapist drift and incorporation of therapeutic interventions that are not described in the FBT manual. Adherence to manualized treatments may improve outcome for some patients, while allowing for flexibility to address clinical situations that are not addressed in the manual. LEVEL OF EVIDENCE V. Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
- Stephanie Jacobs
- Private Practice, New York, NY, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Renee D Rienecke
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, 333 N. Michigan Avenue, Ste. 1900, Chicago, IL, 60601, USA. .,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA.
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29
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Kehle-Forbes SM, Ackland PE, Spoont MR, Meis LA, Orazem RJ, Lyon A, Valenstein-Mah HR, Schnurr PP, Zickmund SL, Foa EB, Chard KM, Alpert E, Polusny MA. Divergent experiences of U.S. veterans who did and did not complete trauma-focused therapies for PTSD: A national qualitative study of treatment dropout. Behav Res Ther 2022; 154:104123. [PMID: 35644083 PMCID: PMC9873271 DOI: 10.1016/j.brat.2022.104123] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/04/2022] [Accepted: 05/13/2022] [Indexed: 01/26/2023]
Abstract
Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) are first-line treatments for posttraumatic stress disorder (PTSD) and have been disseminated throughout the U.S. Veterans Health Administration. Treatment non-completion is common and lessens clinical effectiveness; however, prior work has failed to identify factors consistently associated with non-completion. Semi-structured interviews were conducted with a national sample of veterans who recently completed (n = 60) or did not complete (n = 66) PE or CPT. Non-completer interviews focused on factors that contributed to veterans' decisions to drop out and efforts undertaken to complete PE/CPT. Completer interviews focused on challenges faced in completing treatment and facilitators of completion. Transcripts were coded using a mixed deductive/inductive approach; constant comparison was used to identify differences between completers and non-completers. Completers and non-completers differed in the extent of treatment-specific therapist support received, therapists' flexibility in treatment delivery, the type of encouragement offered by the care team and social supports, their interpretation of symptom worsening, the perceived impact of treatment on functioning, and the impact of stressors on their treatment engagement. Treatment-specific therapist support, more patient-centered and flexible treatment delivery, leveraging the full care team, and addressing functional concerns are potential targets for PE and CPT engagement interventions.
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Affiliation(s)
- Shannon M. Kehle-Forbes
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA,Women’s Health Sciences Division at VA Boston, National Center for PTSD, 150 S Huntington Ave, Boston, MA, 02130, USA,University of Minnesota, Department of Medicine, 420 Delaware St SE, Minneapolis, MN, 55455, USA,Corresponding author. Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA. (S.M. Kehle-Forbes)
| | - Princess E. Ackland
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA,University of Minnesota, Department of Medicine, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Michele R. Spoont
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA,University of Minnesota, Department of Medicine, 420 Delaware St SE, Minneapolis, MN, 55455, USA,National Center for PTSD, Pacific Islands Division, 459 Patterson Rd, Honolulu, HI, 96819, USA
| | - Laura A. Meis
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA,University of Minnesota, Department of Medicine, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Robert J. Orazem
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA
| | - Alexandra Lyon
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA
| | - Helen R. Valenstein-Mah
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA
| | - Paula P. Schnurr
- National Center for PTSD, Department of Veterans Affairs, 163 Veterans Dr, White River Junction, VT, 05009, USA,Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Rd, Hanover, NH, 03755, USA
| | - Susan L. Zickmund
- Informatics, Decision-Enhancement & Analytic Sciences Center, Salt Lake City VA, 500 S Foothill Blvd, Salt Lake City, UT, 84108, USA
| | - Edna B. Foa
- Department of Psychiatry, University of Pennsylvania, 6th Gateway, 3535 Market St, Philadelphia, PA, 19104, USA
| | - Kathleen M. Chard
- Cincinnati VA Medical Center, 3200 Vine St, Cincinnati, OH, 45220, USA
| | - Elizabeth Alpert
- Women’s Health Sciences Division at VA Boston, National Center for PTSD, 150 S Huntington Ave, Boston, MA, 02130, USA
| | - Melissa A. Polusny
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA,University of Minnesota, Department of Psychiatry, 420 Delaware St SE, Minneapolis, MN, 55455, USA
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30
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Luis Sanchez BE, Klein CC, Corcoran F, Barnett ML. A Mixed-Methods Study of Clinician Adaptations to Parent-Child Interaction Therapy - What about Culture? EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 8:269-285. [PMID: 37456065 PMCID: PMC10348697 DOI: 10.1080/23794925.2022.2070883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Parent-Child Interaction Therapy (PCIT) is an evidence-based practice (EBP) for young children with challenging behaviors. PCIT has been adapted to treat varying presentations and culturally diverse families. Although efforts have been made to disseminate PCIT into community settings, which often serve clinically complex, socio-culturally diverse, and marginalized communities, barriers to disseminating adapted models remain. An alternative strategy to understanding how to increase access to appropriately adapted PCIT is to learn from community clinicians' practice-based adaptations to meet their clients' diverse needs related to clinical presentation, culture, and language. This mixed-method study investigated community clinician adaptations of PCIT. Clinicians (N = 314) were recruited via PCIT listservs to complete a survey collecting background information, and adaptations to PCIT. Most clinicians had a master's degree (72.1%), were licensed (74.2%), and were PCIT-certified (70.7%). Qualitative interviews were conducted with a purposeful sample of 23 community clinicians, who were 39% Spanish-speaking, were 30% Latinx, and 30% reported serving a ≥50% Latinx clientele. Clinicians reported engaging in adaptations aimed at augmenting PCIT more extensively than adaptations involving removing core components. Themes from qualitative interviews converged with quantitative findings, with clinicians most frequently describing augmenting adaptations, and highlighted reasons for adapting PCIT. Clinicians primarily augmented treatment to address clients' clinical presentations. Clinicians rarely adapted treatment specifically for culture, but when mentioned, clinicians discussed tailoring idioms and phrases to match clients' culture for Spanish-speaking clients. Implications for training PCIT clinicians in intervention adaptations will be discussed.
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Affiliation(s)
| | | | | | - Miya L Barnett
- University of California Santa Barbara, Santa Barbara, CA
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31
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McGuire A, Matthias MS, Kukla M, Henry N, Carter J, Flanagan M, Bair MJ, Murphy JL. A National Survey of Patient Completion of Cognitive Behavioral Therapy for Chronic Pain: The Role of Therapist Characteristics, Attempt Rates, and Modification. PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2022; 52:542-550. [PMID: 35095180 DOI: 10.1037/pro0000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The implementation of evidence-based psychotherapies, including patient-level measures such as penetration and rates of successfully completing a course of therapy, has received increasing attention. While much attention has been paid to the effect of patient-level factors on implementation, relatively little attention has been paid to therapist factors (e.g., professional training, experience). Objective The current study explores therapists' decisions to offer a particular evidence-based psychotherapy (cognitive behavioral therapy for chronic pain; CBT-CP), whether and how they modify CBT-CP, and the relationship between these decisions and patient completion rates. Methods The study utilized survey responses from 141 Veterans Affairs therapists certified in CBT-CP. Results Therapists reported attempting CBT-CP with a little less than one half of their patients with chronic pain (mean = 48.8%, s.d.=35.7). Therapist were generally split between reporting modifying CBT-CP for either very few or most of their patients. After controlling for therapist characteristics and modification, therapist-reported percentage of patients with attempted CBT-CP was positively associated with completion rates, t (111) = 4.57, p<.001. Conclusions Therapists who attempt CBT-CP more frequently may experience better completion rates, perhaps due to practice effects or contextual factors that support both attempts and completion. Future research should examine this relationship using objective measures of attempt rates and completion.
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Affiliation(s)
- Alan McGuire
- Clinical Research Psychologist at the Richard L. Roudebush VA Medical Center in the HSR&D Center for Health Information and Communication and an Associate Research Professor in the Department of Psychology at Indiana University-Purdue University at Indianapolis
| | - Marianne S Matthias
- Research Scientist at the Roudebush VA Medical Center and Regenstrief Institute in Indianapolis, IN, and Associate Research Professor in the Department of General Internal Medicine and Geriatrics at the Indiana University School of Medicine
| | - Marina Kukla
- Research Scientist and Clinical Psychologist at the Richard L. Roudebush VA Medical Center in the HSR&D Center for Health Information and Communication and an Associate Research Professor in the Department of Psychology at Indiana University-Purdue University at Indianapolis
| | - Nancy Henry
- project manager for the Richard L. Roudebush VA Medical Center in the HSR&D Center for Health Information and Communication and the Department of Psychology at Indiana University-Purdue University at Indianapolis
| | - Jessica Carter
- research assistant for the Richard L. Roudebush VA Medical Center in the HSR&D Center for Health Information and Communication
| | - Mindy Flanagan
- Senior Research Scientist at Parkview Health and Research Consultant at Richard L. Roudebush VA HSR&D Center for Health Information and Communication
| | - Matthew J Bair
- Research Scientist for the Richard L. Roudebush VA Health Services Research and Development Center for Health Information and Communication, Staff Physician at Richard L. Roudebush VA Medical Center, and Regenstrief Research Scientist
| | - Jennifer L Murphy
- Director of Behavioral Pain Medicine for the Veterans Health Administration and is Master Trainer for VA's Cognitive Behavioral Therapy for Chronic Pain (CBT-CP). Dr. Murphy is Associate Professor in the University of South Florida's Morsani College of Medicine and serves on the editorial board of Pain Medicine
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McLeod BD, Martinez RG, Southam-Gerow MA, Weisz JR, Chorpita BF. Can a Single Measure Estimate Protocol Adherence for Two Psychosocial Treatments for Youth Anxiety Delivered in Community Mental Health Settings? Behav Ther 2022; 53:119-136. [PMID: 35027154 PMCID: PMC8760467 DOI: 10.1016/j.beth.2021.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 01/03/2023]
Abstract
Treatment adherence measurement can be time and resource-intensive in clinical trials, so the ability to measure protocol adherence for two distinct treatment programs with a single measure may benefit the field. The present study sought to determine if the Therapy Process Observational Coding System - Revised Strategies Scale (TPOCS-RS) could assess protocol adherence to two youth treatment programs. Treatment sessions (N = 796) from 55 youth (M age = 9.89 years, SD = 1.71; range 7-15 years; 55.0% White; 46.0% female) with primary anxiety problems treatment by 39 clinicians (M age = 40.54 years, SD = 9.56; 50.0% White; 80.0% female) were independently scored by coders using observational treatment adherence and alliance measures. The youth received one of three treatments: (a) Standard (i.e., cognitive-behavioral treatment program), (b) Modular (i.e., a program with cognitive-behavioral and parent training components), or (c) Usual Care. Consultants filled out a self-report measure of protocol adherence within the Standard and Modular conditions. Interrater reliability, ICC(2,2) for the various items for the full sample ranged from .17 to .92 (M ICC = .67; SD = .17). Scores from a TPOCS-RS subscale that mapped onto the specific content of the treatment protocols used in the Standard and Modular conditions evidenced convergent validity with the consultant-report adherence measure and discriminant validity with the alliance measure. The model-specific TPOCS-RS subscales also discriminated between the Standard and Modular treatments and Usual Care. This study provides initial evidence that (a) the TPOCS-RS has utility in estimating protocol adherence in different treatment programs and (b) support the score validity of the self-report consultation records.
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Affiliation(s)
| | - Ruben G Martinez
- Virginia Commonwealth University; University of California, Los Angeles
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Steil R, Müller-Engelmann M, Stangier U, Priebe K, Fydrich T, Weiß J, Dittmann C. Scales for assessing therapeutic adherence and competence in dialectical behaviour therapy for PTSD: development and analysis of psychometric properties. Eur J Psychotraumatol 2022; 13:2055293. [PMID: 35386730 PMCID: PMC8979536 DOI: 10.1080/20008198.2022.2055293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The assessment of therapeutic adherence and competence is essential to understand mechanisms that contribute to treatment outcome. Nevertheless, their assessment is often neglected in psychotherapy research. AIMS/OBJECTIVE To develop an adherence and a treatment-specific competence rating scale for Dialectical Behaviour Therapy for Posttraumatic Stress Disorder (DBT-PTSD), and to examine their psychometric properties. Global cognitive behavioural therapeutic competence and disorder-specific therapeutic competence were assessed using already existing scales to confirm their psychometric properties in our sample of patients with PTSD and emotion regulation difficulties. METHOD Two rating scales were developed using an inductive procedure. 155 videotaped therapy sessions from a multicenter randomised controlled trial were rated by trained raters using these scales, 40 randomly chosen videotapes involving eleven therapists and fourteen patients were doubly rated by two raters. RESULTS Both the adherence scale (Patient-level ICC = .98; αs = .65; α p = .75) and the treatment-specific competence scale (Patient-level ICC = .98; αs = .78; α p = .82) for DBT-PTSD showed excellent interrater - and good reliability on the patient level. Content validity, including relevance and appropriateness of all items, was confirmed by experts in DBT-PTSD for the new treatment-specific competence scale. CONCLUSION Our results indicate that both scales are reliable instruments. They will be useful to examine possible effects of adherence and treatment-specific competence on DBT-PTSD treatment outcome.
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Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Kathlen Priebe
- Department of Psychology, Faculty of Life Sciences, Humboldt-University of Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Fydrich
- Department of Psychology, Faculty of Life Sciences, Humboldt-University of Berlin, Berlin, Germany
| | - Judith Weiß
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Clara Dittmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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ElBarazi A, Tikamdas R, Ahmed S, Ramadan S. Cognitive Processing Therapy for the Treatment of PTSD, Depression and Anxiety in Syrian Refugees in Egypt. INTERVENTION 2022. [DOI: 10.4103/intv.intv_33_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Yu SH, Brookman-Frazee L, Kim JJ, Barnett ML, Wright B, Lau AS. Therapist adaptations to evidence-based practices and associations with implementation outcomes in child therapy sessions. J Consult Clin Psychol 2022; 90:39-50. [PMID: 34410750 PMCID: PMC8857284 DOI: 10.1037/ccp0000667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Community therapists inevitably adapt evidence-based practices (EBPs) to meet the needs of their clients and practice settings. Yet, the implications of spontaneous, therapist-driven adaptations for EBP implementation outcomes are not well understood. We used a sequential QUAN → qual mixed-methods design to examine how different types of therapist-described adaptations were associated with observer-rated extensiveness of therapist delivery of EBP content and technique strategies at the session level. METHOD Data were drawn from an observational study of a system-driven implementation of multiple EBPs into public children's mental health services. Community therapists (n = 103) described adaptations they made in 680 sessions with 273 clients (50.92% female, 49.08% male, Mage = 9.72 years, 70.70% Hispanic/Latinx). Coders classified therapist-described adaptations into five types: (a) Modifying Presentation, (b) Integrating, (c) Extending, (d) Reducing, and (e) Generalizing. Independent observers rated the extensiveness of EBP strategy delivery from session recordings using the EBP Concordant Care Assessment (ECCA) Observational Coding System. RESULTS Quantitative analyses using multilevel regression revealed that Modifying Presentation adaptations were associated with higher extensiveness of EBP technique delivery, whereas Extending adaptations were associated with lower extensiveness of EBP content and technique delivery. Qualitative analysis of adaptation descriptions identified explanations for the quantitative findings. CONCLUSIONS Findings suggest that Modifying Presentation adaptations, associated with higher extensiveness, involved creative use of activities and materials, language modification, and personalization of EBP content to meet clients' diverse needs, whereas Extending adaptations, associated with lower extensiveness, involved slowing EBP pacing in response to client challenges. Implications for provider training are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Stephanie H. Yu
- Department of Psychology, University of California, Los Angeles, CA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, CA,Child and Adolescent Services Research Center (CASRC), San Diego, CA
| | - Joanna J. Kim
- Department of Psychology, Arizona State University, Phoenix, AZ
| | - Miya L. Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, CA
| | - Blanche Wright
- Department of Psychology, University of California, Los Angeles, CA
| | - Anna S. Lau
- Department of Psychology, University of California, Los Angeles, CA
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Williston SK, Kruepke M, Grossman D, Litwack S, Niles BL. Exploring Modifications to Individual Trauma-Focused PTSD Treatments in a Routine Care Setting: An Examination of Medical Records at a Veterans Health Administration PTSD Clinic. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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37
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Treatment Fidelity in Brief Versus Standard-Length School-Based Interventions for Youth with Anxiety. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09458-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractTo examine treatment fidelity in a randomized controlled trial of indicated school-based cognitive-behavioral therapy (CBT) delivered in groups to youth with anxiety. We investigated whether adherence and competence (a) differed across brief and standard-length CBT, and (b) if adherence and competence predicted change in anxiety symptoms and impairment. Method: Sessions were observationally coded with the Competence and Adherence Scale for CBT for Anxiety Disorders in Youth. Coders (N = 7) rated 104 sessions from 52 groups delivered by 32 facilitators (M age = 43.2 years, SD = 8.1) to 295 youth (M age = 14.0 years, SD = 0.8). Outcomes were youth- and parent-reported anxiety symptoms and impairment at post-intervention and 1-year follow-up. Linear mixed effect models were used to analyze whether fidelity predicted clinical outcomes. Results: Levels of adherence and competence were adequate in both programs, but higher in brief compared to standard-length CBT p < .001 and p = .010, respectively). Neither adherence nor competence predicted clinical outcomes at any timepoints. Conclusion: Higher levels of adherence and competence in brief CBT suggest that it may be easier for novice CBT providers to achieve fidelity in simplified and less flexible interventions. Contrary to expectation, adherence and competence did not predict clinical outcomes.
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Rose AL, McBain R, Wilson J, Coleman SF, Mathieu E, Fils-Aimé JR, Affricot E, Thérosmé T, Dubuisson W, Eustache E, Smith SL, Raviola G. Evaluating clinical outcomes of routinely delivered task-shared care for depression in rural Haiti. Glob Ment Health (Camb) 2021; 8:e19. [PMID: 34168884 PMCID: PMC8192595 DOI: 10.1017/gmh.2021.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/02/2021] [Accepted: 04/22/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND There is a growing literature in support of the effectiveness of task-shared mental health interventions in resource-limited settings globally. However, despite evidence that effect sizes are greater in research studies than actual care, the literature is sparse on the impact of such interventions as delivered in routine care. In this paper, we examine the clinical outcomes of routine depression care in a task-shared mental health system established in rural Haiti by the international health care organization Partners In Health, in collaboration with the Haitian Ministry of Health, following the 2010 earthquake. METHODS For patients seeking depression care betw|een January 2016 and December 2019, we conducted mixed-effects longitudinal regression to quantify the effect of depression visit dose on symptoms, incorporating interaction effects to examine the relationship between baseline severity and dose. RESULTS 306 patients attended 2052 visits. Each visit was associated with an average reduction of 1.11 in depression score (range 0-39), controlling for sex, age, and days in treatment (95% CI -1.478 to -0.91; p < 0.001). Patients with more severe symptoms experienced greater improvement as a function of visits (p = 0.04). Psychotherapy was provided less frequently and medication more often than expected for patients with moderate symptoms. CONCLUSIONS Our findings support the potential positive impact of scaling up routine mental health services in low- and middle-income countries, despite greater than expected variability in service provision, as well as the importance of understanding potential barriers and facilitators to care as they occur in resource-limited settings.
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Affiliation(s)
- Alexandra L. Rose
- Department of Psychology, University of Maryland, College Park, USA
- Partners in Health, Boston, USA
| | - Ryan McBain
- Partners in Health, Boston, USA
- RAND Corporation, Boston, USA
| | | | | | | | | | | | | | | | | | - Stephanie L. Smith
- Partners in Health, Boston, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Giuseppe Raviola
- Partners in Health, Boston, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
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Stirman SW, Gutner CA, Gamarra J, Suvak MK, Vogt D, Johnson C, Wachen JS, Dondanville KA, Yarvis JS, Mintz J, Peterson AL, Young-McCaughan S, Resick PA. A Novel Approach to the Assessment of Fidelity to a Cognitive Behavioral Therapy for PTSD Using Clinical Worksheets: A Proof of Concept With Cognitive Processing Therapy. Behav Ther 2021; 52:656-672. [PMID: 33990240 DOI: 10.1016/j.beth.2020.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
Abstract
Fidelity monitoring is a critical indicator of psychotherapy quality and is central to successful implementation. A major barrier to fidelity in routine care is the lack of feasible, scalable, and valid measurement strategies. A reliable, low-burden fidelity assessment would promote sustained implementation of cognitive behavioral therapies (CBTs). The current study examined fidelity measurement for cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) using clinical worksheets. External raters evaluated patient worksheets done as a part of treatment, both guided by the therapist and completed independently as homework. Results demonstrated that fidelity ratings from CPT session worksheets were feasible and efficient. Notably, they were strongly correlated with observer ratings of the fidelity of CPT strategies that were present on the worksheets. Agreement among ratings conducted by individuals with a range of experience with CPT was acceptable to high. There was not a main effect of therapist-guided, in-session worksheet ratings on PTSD symptom change. However, patient competence in completing worksheets independently was associated with greater PTSD symptom decline and in-session, therapist-guided worksheet completion was associated with larger symptom decreases among patients with high levels of competence. With further research and refinement, rating of worksheets may be an efficient way to examine therapist and patient skill in key CPT elements, and their interactions, compared to the gold standard of observer ratings of therapy video-recordings. Additional research is needed to determine if worksheets are an accurate and scalable alternative to gold standard observer ratings in settings in which time and resources are limited.
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Affiliation(s)
- Shannon Wiltsey Stirman
- Dissemination and Training Division, National Center for PTSD, VA Palo Alto Healthcare System & Stanford University.
| | - Cassidy A Gutner
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System &; Boston University School of Medicine
| | | | | | - Dawne Vogt
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System &; Boston University School of Medicine
| | - Clara Johnson
- Dissemination and Training Division, National Center for PTSD
| | - Jennifer Schuster Wachen
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System &; Boston University School of Medicine
| | | | | | - Jim Mintz
- University of Texas Health Science Center at San Antonio
| | - Alan L Peterson
- University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System; University of Texas at San Antonio
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40
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Ametaj AA, Smith AM, Valentine SE. A Stakeholder-Engaged Process for Adapting an Evidence-Based Intervention for Posttraumatic Stress Disorder for Peer Delivery. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:793-809. [PMID: 33813717 DOI: 10.1007/s10488-021-01129-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Peer providers represent a growing sector of the U.S. workforce, yet guidance is needed on best practices for adapting behavioral health interventions for peer delivery. METHODS We utilized the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME; Wiltsey Stirman et al. 2013, 2019) to describe how we systematically adapted Skills Training in Affective and Interpersonal Regulation (STAIR) for posttraumatic stress disorder (PTSD) for peer delivery. Our process was iterative and relied on engagement of multiple stakeholders, including a work group of organizational leaders (N = 5), peer interventionists (N = 4), intervention experts (N = 2), and trial participants (N = 18). The FRAME was used to guide rapid coding across multiple data sources, including researcher field notes, meeting minutes, and intervention manual documents, and content analysis of semi-structured interviews with peer interventionists and trial participants. RESULTS Phase 1 (pre-trial) focused on modifications for fit with the local context and peer model. Key modifications focused on improving intervention design and packaging, removing clinical and stigmatizing language, and addressing peer interventionist training gaps. We used a hybrid approach to delivery, whereby we integrated peer model principles (self-disclosure, mutuality) into a directive approach. Phase 2 (trial) included reactive fidelity-consistent adaptations, such as additional educational resources. Phase 3 (post-trial) focused on adaptations to support roll-out of the intervention at the peer organization (e.g., group format). CONCLUSION Our stakeholder-engaged process may serve as a helpful exemplar to others tailoring interventions for peer delivery. Future research is needed to understand the role of stakeholder engagement and adaptation in implementation success.
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Affiliation(s)
- Amantia A Ametaj
- Department of Epidemiology, Harvard Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Ash M Smith
- Department of Psychiatry, Boston Medical Center, 720 Harrison Ave, Suite 1150, Boston, MA, 02118, USA
| | - Sarah E Valentine
- Department of Psychiatry, Boston Medical Center, 720 Harrison Ave, Suite 1150, Boston, MA, 02118, USA. .,Department of Psychiatry, Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
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41
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Youn SJ, Aguilar-Silvan Y, Baldwin M, Chablani-Medley A, Patrick KA, Shtasel DL, Marques L. Ensuring the fit of an evidence-based curriculum for high-risk Latina young mothers using implementation science. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:737-755. [PMID: 31999381 DOI: 10.1002/jcop.22321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
Conduct a comprehensive needs assessment to evaluate the fit of a Cognitive Behavioral Theory (CBT) curriculum implemented within a community organization and inform possible adaptations to fit the mental health difficulties of high-risk Latina young mothers. The PRECEDE-PROCEED implementation framework guided the assessment and results. Focus groups were conducted with high-risk Latina young mothers and staff members to assess the priority mental health problems, environmental stressors and factors contributing and maintaining these difficulties, and existing resources that could be leveraged to address them. Latina young mothers experience a variety of mental health needs and immigration and interpersonal-related stressors. The organization's existing CBT curriculum was found to be feasible and a good fit for the target population. Proposed minor adaptations included a focus on parenting. Results support the robust effects of CBT interventions, including when delivered by paraprofessionals to a high-risk population in a low-resource community setting.
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Affiliation(s)
- Soo Jeong Youn
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Kaylie A Patrick
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Derri L Shtasel
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Ametaj AA, Wilner Tirpak J, Cassiello-Robbins C, Snow R, Rassaby MM, Beer K, Sauer-Zavala S. A Preliminary Investigation of Provider Attitudes Toward a Transdiagnostic Treatment: Outcomes from Training Workshops with the Unified Protocol. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:668-682. [PMID: 33538945 DOI: 10.1007/s10488-020-01101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
Evidence-based psychological treatments (EBPTs) for common mental health conditions are efficacious but remain underutilized in clinical service settings. Novel transdiagnostic and modular approaches that treat several disorders simultaneously promise to address common barriers to the dissemination and implementation of traditional EBPTs. Despite the promise that transdiagnostic treatments hold, the claims that these interventions can be more easily disseminated and implemented have not been widely tested. The present study examined whether a transdiagnostic treatment, the Unified Protocol (UP), addresses some barriers to dissemination and implementation for clinicians. Exploratory aims of the current study were to examine the effects of a UP introductory training workshop on clinician attitudes and behaviors by: (1) evaluating UP knowledge and treatment delivery, (2) determining relationships between clinician characteristics and their knowledge acquisition, satisfaction with UP, and UP penetration, and (3) exploring clinicians' perceptions of the UP's characteristics utilizing mixed methods. Workshop participants showed a good understanding of UP treatment concepts following training, and over a third of survey respondents reported use of the intervention 6-months after training. Positive attitudes toward EBPTs and fewer years of clinical practice were associated with greater satisfaction with the UP. Clinicians held positive views of the UP's flexibility and relative advantage over standard EBPTs but held negative views toward the manual's design and packaging. Overall, our findings suggest that clinicians may view transdiagnostic treatments such as the UP favorably and may consider them appealing over standard EBPTs. However, barriers associated with traditional EBPTs may extend to transdiagnostic treatments like the UP.
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Affiliation(s)
- Amantia A Ametaj
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA. .,Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02215, USA.
| | | | - Clair Cassiello-Robbins
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Rachel Snow
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Madeleine M Rassaby
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Kelsey Beer
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Assessing Implementation Strategy Reporting in the Mental Health Literature: A Narrative Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:19-35. [PMID: 31482489 DOI: 10.1007/s10488-019-00965-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Inadequate implementation strategy reporting restricts research synthesis and replicability. We explored the implementation strategy reporting quality of a sample of mental health articles using Proctor et al.'s (Implement Sci 8:139, 2013) reporting recommendations. We conducted a narrative review to generate the sample of articles and assigned a reporting quality score to each article. The mean article reporting score was 54% (range 17-100%). The most reported domains were: name (100%), action (82%), target (80%), and actor (67%). The least reported domains included definition (6%), temporality (26%), justification (34%), and outcome (37%). We discuss limitations and provide recommendations to improve reporting.
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Mallard Swanson K, Song J, Beristianos M, Aajmain S, Lane JE, Landy MS, Suvak MK, Shields N, Monson CM, Stirman SW. A Glimpse into the "Black Box": Which Elements of Consultation in an EBP are Associated with Client Symptom Change and Therapist Fidelity? IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211051791. [PMID: 37090000 PMCID: PMC9978606 DOI: 10.1177/26334895211051791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Consultation is an implementation strategy that improves delivery and clinical outcomes for Cognitive Processing Therapy (CPT), an evidence-based practice (EBP) for posttraumatic stress disorder (PTSD). However, little is known about the specific components of consultation that influence the fidelity of treatment delivery or clinical outcomes. Methods: The current study examined whether specific activities performed during CPT consultation meetings were associated with better fidelity to the CPT protocol among 60 newly trained therapists or improved clinical outcomes among 135 clients treated by these therapists. Consultation activities that fall under three broad categories (discussion of the application of CPT to individual cases, review/feedback on fidelity, and technical difficulties) were measured by consultant checklists for each consultation session. Treatment fidelity (adherence to the protocol and competence of delivery) was rated by trained observers for a random sample of therapists' CPT sessions following consultation. The self-reported PTSD Checklist-IV assessed PTSD symptom change. Results: Multilevel regression analyses indicated that higher therapist consultation attendance predicted a greater decrease in their clients' PTSD symptoms and that attendance was not associated with observer-rated treatment fidelity. Discussion of the application of specific CPT strategies was the only consultation activity that was significantly associated with greater improvement in PTSD symptoms. Lastly, no consultation activities were significantly associated with treatment fidelity. Conclusions: Our findings suggest that specific consultation strategies such as emphasizing the discussion of the application of specific CPT strategies to individual cases during consultation meetings may be effective in improving the clinical outcomes of CPT.
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Affiliation(s)
| | - Jiyoung Song
- National Center for PTSD and Stanford University, Menlo Park, CA,
USA
| | | | - Syed Aajmain
- National Center for PTSD and Stanford University, Menlo Park, CA,
USA
| | - Jeanine E.M. Lane
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | | | | | - Norman Shields
- Royal Canadian Mounted
Police, Divisional Psychologist Occupational Health and Safety
Services, Ottawa, Ontario, Canada
| | - Candice M. Monson
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
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Stirman SW. Commentary: Challenges and Opportunites in the Assessment of Fidelity and Related Constructs. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:932-934. [PMID: 32715432 DOI: 10.1007/s10488-020-01069-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Shannon Wiltsey Stirman
- National Center for PTSD and Stanford University, 795 Willow Rd, NC-PTSD, Menlo Park, CA, 94025, USA.
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46
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Adapting Cognitive Processing Therapy for PTSD for People With Disabilities: A Case Study With a U.S. Veteran. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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47
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Peterson AL, Foa EB, Resick PA, Hoyt TV, Straud CL, Moore BA, Favret JV, Hale WJ, Litz BT, Rogers TE, Stone JM, Villarreal R, Woodson CS, Young-McCaughan S, Mintz J. A Nonrandomized Trial of Prolonged Exposure and Cognitive Processing Therapy for Combat-Related Posttraumatic Stress Disorder in a Deployed Setting. Behav Ther 2020; 51:882-894. [PMID: 33051031 DOI: 10.1016/j.beth.2020.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/24/2019] [Accepted: 01/03/2020] [Indexed: 11/18/2022]
Abstract
For many decades, the U.S. military's general operational guideline has been to limit the use of trauma-focused treatments for combat and operational stress reactions in military service members until they have returned from deployment. Recently, published clinical trials have documented that active-duty military personnel with combat-related posttraumatic stress disorder (PTSD) can be treated effectively in garrison. However, there are limited data on the treatment of combat and operational stress reactions or combat-related PTSD during military deployments. This prospective, nonrandomized trial evaluated the treatment of active-duty service members (N = 12) with combat and operational stress reactions or combat-related PTSD while deployed to Afghanistan or Iraq. Service members were treated by deployed military behavioral health providers using modified Prolonged Exposure (PE; n = 6) or modified Cognitive Processing Therapy (CPT; n = 6), with protocol modifications tailored to individual mission requirements. The PTSD Checklist-Military Version (PCL-M) total score was the primary outcome measure. Results indicated that both groups demonstrated clinically significant change in PTSD symptoms as indicated by a reduction of 10 points or greater on the PCL-M. Participants treated with modified PE had significant reductions in PTSD symptoms, t = -3.83, p = .01; g = -1.32, with a mean reduction of 18.17 points on the PCL-M. Participants treated with modified CPT had a mean PCL-M reduction of 10.00 points, but these reductions were not statistically significant, t = -1.49, p = .12; g = -0.51. These findings provide preliminary evidence that modified forms of PE and CPT can be implemented in deployed settings for the treatment of combat and operational stress reactions and combat-related PTSD.
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Affiliation(s)
- Alan L Peterson
- University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System, San Antonio; University of Texas at San Antonio.
| | | | | | | | - Casey L Straud
- University of Texas Health Science Center at San Antonio; University of Texas at San Antonio
| | - Brian A Moore
- University of Texas Health Science Center at San Antonio; University of Texas at San Antonio
| | | | - Willie J Hale
- University of Texas Health Science Center at San Antonio; University of Texas at San Antonio
| | | | - Timothy E Rogers
- Uniformed Services University of the Health Sciences; Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX
| | | | | | | | | | - Jim Mintz
- University of Texas Health Science Center at San Antonio
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Gumport NB, Yu SH, Harvey AG. Implementing a transdiagnostic sleep and circadian intervention in a community mental health setting: A qualitative process evaluation with community stakeholders. Psychiatry Res 2020; 293:113443. [PMID: 32890862 DOI: 10.1016/j.psychres.2020.113443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
The implementation of evidence-based psychological treatments (EBPTs) may be particularly challenging to accomplish in community mental health settings for individuals with severe mental illness (SMI). Transdiagnostic treatments, or treatments that target a mechanism that underpins multiple mental health problems, may be particularly well-suited to community mental health settings. This study examines community stakeholder perspectives (N = 22) of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) implemented in a community mental health setting in the context of a randomized controlled trial of TranS-C for SMI. The present study aimed to identify barriers and facilitators to the implementation of TranS-C for SMI in a community mental health setting using (1) a deductive theory-based process based on the Framework for Dissemination in Health Services Intervention Research and (2) an inductive thematic analysis process. All deductive themes were identified as both barriers and facilitators to the implementation of EBPTs and TranS-C in this community mental health setting. Seven additional themes were identified through the inductive thematic analysis. A discussion of how the findings are related to prior research, other EBPT implementation, and future TranS-C implementation are included.
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Affiliation(s)
- Nicole B Gumport
- Department of Psychology, University of California, 2121 Berkeley Way #1650, Berkeley, CA, United States
| | - Stephanie H Yu
- Department of Psychology, University of California, 2121 Berkeley Way #1650, Berkeley, CA, United States; Department of Psychology, University of California, Los Angeles, CA, United States
| | - Allison G Harvey
- Department of Psychology, University of California, 2121 Berkeley Way #1650, Berkeley, CA, United States.
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Pace BT, Song J, Suvak MK, Shields N, Monson CM, Stirman SW. Therapist Self-Efficacy in Delivering Cognitive Processing Therapy in a Randomized Controlled Implementation Trial. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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50
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Çankaya S, Dikmen HA. The relationship between posttraumatic stress symptoms of maternity professionals and quality of work life, cognitive status, and traumatic perinatal experiences. Arch Psychiatr Nurs 2020; 34:251-260. [PMID: 32828357 DOI: 10.1016/j.apnu.2020.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to determine the relationship between posttraumatic stress symptoms of maternity nursing/midwife and their quality of work life, cognitive distortions, and traumatic perinatal experiences. METHODS A descriptive, cross-sectional survey design was used. Two hundred and sixty-six maternity nurses/midwives employed in maternity units of hospitals in a province located in the Central Anatolia Region of Turkey were included in the study. RESULTS 37.2% of the maternity nurses/midwives met the criteria for posttraumatic stress disorder (% 95 CI [31.6, 43.2]). Previous birth-related traumatic experiences, transferring to another unit, and negative cognitions about the self-increase the risk of development of posttraumatic stress disorder by 63% (F = 7.638, P < 0.001). A positive correlation was found between the outcome variable PTS total score and the following predictors: the number of years in the profession, the number of traumatizing events, quality of work life, burnout symptoms, compassion fatigue, posttraumatic cognition, negative cognition about the world, and negative cognition about the self. It was found that those maternity nurses/midwives who were not happy with their profession, who witnessed a traumatic incident, who transferred to another unit, who considered to quit the profession, who had a history of a psychological disorder, and those lacked social life were more sensitive to posttraumatic stress symptoms. CONCLUSION These outcomes have significant consequences for both personal and professional well-being of the maternity nurses/midwives and the welfare of the workforce. To prepare maternity nurses/midwives for such exposures, to support maternity nurses/midwives following traumatic perinatal events, and to provide effective intervention for those with significant symptoms, organizational strategies are necessary.
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Affiliation(s)
- Seyhan Çankaya
- Department of Midwifery, Health Sciences Faculty of Selcuk University, Konya, Turkey.
| | - Hacer Alan Dikmen
- Department of Midwifery, Health Sciences Faculty of Selcuk University, Konya, Turkey
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