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Bassi E, Bright K, Norman L, Pintson K, Daniel S, Sidhu S, Gondziola J, Bradley J, Fersovitch M, Stamp L, Moskovic K, LaMonica H, Iorfino F, Gaskell T, Tomlinson S, Johnson D, Dimitropoulos G. Perceptions of mental health providers of the barriers and facilitators of using and engaging youth in digital mental-health-enabled measurement based care. Digit Health 2024; 10:20552076241253093. [PMID: 38726214 PMCID: PMC11080807 DOI: 10.1177/20552076241253093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives Increased rates of mental health disorders and substance use among youth and young adults have increased globally, furthering the strain on an already burdened mental health system. Digital solutions have been proposed as a potential option for the provision of timely mental health services for youth, with little research exploring mental health professional views about using such innovative tools. In Alberta, Canada, we are evaluating the implementation and integration of a digital mental health (dMH) platform into existing service pathways. Within this paper we seek to explore mental health professionals' perceptions of the barriers and facilitators that may influence their utilization of digital MH-enabled measurement-based care (MBC) with the youth who access their services. Methods A qualitative, descriptive methodology was used to inductively generate themes from focus groups conducted with mental health professionals from specialized mental health services and primary care networks in Alberta. Results As mental health professionals considered the barriers and facilitators of using dMH with youth, they referenced individual and family barriers and facilitators to consider. Providers highlighted perceived barriers, including: first, cultural stigma, family apprehension about mental health care, and parental access to dMH and MBC as deterrents to providers adopting digital platforms in routine care; second, perceptions of increased responsibility and liability for youth in crisis; third, perception that some psychiatric and neurodevelopmental disorders in youth are not amenable to dMH; fourth, professionals contemplated youth readiness to engage with dMH-enabled MBC. Participants also highlighted pertinent facilitators to dMH use, noting: first, the suitability of dMH for youth with mild mental health concerns; second, youth motivated to report their changes in mental health symptoms; and lastly, youth proficiency and preference for dMH options. Conclusions By identifying professionals' perceptions of barriers and facilitators for youth users, we may better understand how to address misconceptions about who is eligible and appropriate for dMH through training and education.
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Affiliation(s)
- E.M. Bassi
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - K.S. Bright
- School of Nursing and Midwifery, Faculty of Health, Community, and Education, Mount Royal University, Calgary, Alberta, Canada
- Heroes in Mind, Advocacy, and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, College of Health Science, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - L.G. Norman
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - K. Pintson
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - S. Daniel
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - S. Sidhu
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - J. Gondziola
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - J. Bradley
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - M. Fersovitch
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - L. Stamp
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - K. Moskovic
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - H.M. LaMonica
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - F. Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - T. Gaskell
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - S. Tomlinson
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - D.W. Johnson
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - G. Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
- Calgary Eating Disorders Program, Alberta Health Services, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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Levinson CA, Osborn K, Hooper M, Vanzhula I, Ralph-Nearman C. Evidence-Based Assessments for Transdiagnostic Eating Disorder Symptoms: Guidelines for Current Use and Future Directions. Assessment 2024; 31:145-167. [PMID: 37997290 DOI: 10.1177/10731911231201150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Eating disorders are severe and often chronic mental illnesses that are associated with high impairment and mortality rates. Recent estimates suggest that eating disorder prevalence rates are on the rise, indicating an increased need for accurate assessment and detection. The current review provides an overview of transdiagnostic eating disorder assessments, including interview, self-report, health and primary care screeners, and technology-based and objective assessments. We focused on assessments that are transdiagnostic in nature and exhibit high impact in the field. We provide recommendations for how these assessments should be used in research and clinical settings. We also discuss considerations that are crucial for assessment, including the use of a categorical versus dimensional diagnostic framework, assessment of eating disorders in related fields (i.e., anxiety and depression), and measurement-based care for eating disorders. Finally, we provide suggestions for future research, including the need for more research on short transdiagnostic screeners for use in health care settings, standardized assessments for ecological momentary assessment, development of state-based assessment of eating disorder symptoms, and consideration of assessment across multiple timescales.
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Affiliation(s)
| | - Kimberly Osborn
- University of Louisville, KY, USA
- Oklahoma State University, Stillwater, USA
| | - Madison Hooper
- University of Louisville, KY, USA
- Vanderbilt University, Nashville, TN, USA
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Harris BA, Boswell JF, Hormes JM, Espel-Huynh H, Thompson-Brenner H. A baseline comparison of three diagnostic groups using the Progress Monitoring Tool for Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2023. [PMID: 37209255 DOI: 10.1002/erv.2992] [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: 11/17/2022] [Revised: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
Utilisation of intensive inpatient treatment for eating disorders (EDs) has climbed in the last decade, illuminating a need for better consensus on what constitutes effective treatment and context-appropriate progress/outcome monitoring during residential stays. The novel Progress Monitoring Tool for Eating Disorders (PMED) measure is specifically designed for inpatient settings. Previous research supports the factorial validity and internal consistency of the PMED; however, additional work is needed to determine its appropriateness for complex patient populations. This study used measurement invariance (MI) testing to determine if the PMED administered at programme admission measures the same items in similar ways across patients with anorexia nervosa restricting- and binge-purge subtypes (AN-R; AN-BP) and bulimia nervosa (BN, N = 1121; Mage = 24.33 years, SD = 10.20; 100% female). Progressively constrained models were used to determine the level of invariance upheld between the three groups. Results indicated that, while the PMED meets configural and metric MI, it does not display scalar invariance. Said otherwise, the PMED similarly assesses constructs and items across AN-R, AN-BP, and BN, however the same score overall may reflect different levels of psychopathology for patients in one diagnostic category versus another. Comparisons of severity between different EDs should be made with caution, however the PMED appears to be a sound tool for understanding the baseline functioning of patients with EDs in an inpatient setting.
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Affiliation(s)
- Bethany A Harris
- Department of Psychology, University at Albany, SUNY, Albany, New York, USA
| | - James F Boswell
- Department of Psychology, University at Albany, SUNY, Albany, New York, USA
| | - Julia M Hormes
- Department of Psychology, University at Albany, SUNY, Albany, New York, USA
| | - Hallie Espel-Huynh
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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4
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Marriott BR, Walker MR, Howard J, Puspitasari A, Scott K, Albright K, Lewis CC. Taking a Magnifying Glass to Measurement-Based Care Consultation Sessions: with What Issues Do Mental Health Clinicians Struggle? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:366-378. [PMID: 36542316 PMCID: PMC10201798 DOI: 10.1007/s10488-022-01244-9] [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: 06/22/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Ongoing consultation following initial training is one of the most commonly deployed implementation strategies to facilitate uptake of evidence-based practices, such as measurement-based care (MBC). Group consultation provides an interactive experience with an expert and colleagues to get feedback on actual issues faced, yet there is little research that unpacks the questions raised in consultation and what types of issues are important to address. METHODS The current study characterized the questions and concerns raised by community mental health clinicians (N = 38 across six clinics) during group consultation sessions completed as part of an MBC implementation trial. We conducted a qualitative content analysis of consultation forms completed by clinicians before each MBC consultation session. RESULTS Clinicians sought MBC consultation for clients across a range of ages and levels of depression severity. Qualitative results revealed five main questions and concerns in consultation sessions: (1) how to administer the PHQ-9, (2) how to review PHQ-9 scores, (3) how to respond to PHQ-9 score, (4) the types of clients for whom MBC would be appropriate, and (5) how MBC could impact a clinician's usual care. CONCLUSION Findings highlight the need for ongoing consultation and limitations of workshop training alone. Practical recommendations for addressing the common questions and concerns identified are presented to support MBC use.
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Affiliation(s)
- Brigid R Marriott
- Department of Psychiatry, Indiana University School of Medicine, 410 W. 10th St, 46202, Indianapolis, IN, USA.
| | - Madison R Walker
- University of North Carolina, 135 Dauer Dr, 27599, Chapel Hill, NC, USA
| | | | - Ajeng Puspitasari
- Rogers Behavioral Health, 576 Bielenberg Dr Ste 180, 55125, Woodbury, MN, USA
| | - Kelli Scott
- Brown University, 121 S. Main Street, 02903, Providence, RI, USA
| | - Karen Albright
- Division of General Internal Medicine, University of Colorado School of Medicine, 12631 East 17th Ave, 80045, Aurora, CO, USA
| | - Cara C Lewis
- MacColl Center for Healthcare Innovation, Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, 98101, Seattle, WA, USA
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Barkham M, De Jong K, Delgadillo J, Lutz W. Routine Outcome Monitoring (ROM) and Feedback: Research Review and Recommendations. Psychother Res 2023:1-15. [PMID: 36931228 DOI: 10.1080/10503307.2023.2181114] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVE To provide a research review of the components and outcomes of routine outcome monitoring (ROM) and recommendations for research and therapeutic practice. METHOD A narrative review of the three phases of ROM - data collection, feeding back data, and adapting therapy - and an overview of patient outcomes from 11 meta-analytic studies. RESULTS Patients support ROM when its purpose is clear and integrated within therapy. Greater frequency of data collection is more important for shorter-term therapies, and use of graphs, greater specificity of feedback, and alerts are helpful. Overall effects on patient outcomes are statistically significant (g ≈ 0.15) and increase when clinical support tools (CSTs) are used for not-on-track cases (g ≈ 0.36-0.53). Effects are additive to standard effects of psychological therapies. Organizational, personnel, and resource issues remain the greatest obstacles to the successful adoption of ROM. CONCLUSION ROM offers a low-cost method for enhancing patient outcomes, on average resulting in an ≈ 8% advantage (success rate difference; SRD) over standard care. CSTs are particularly effective for not-on-track patients (SRD between ≈ 20% and 29%), but ROM does not work for all patients and successful implementation is a major challenge, along with securing appropriate cultural adaptations.
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Affiliation(s)
- Michael Barkham
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Kim De Jong
- Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
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6
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Cuperfain AB, Hui K, Berkhout SG, Foussias G, Gratzer D, Kidd SA, Kozloff N, Kurdyak P, Linaksita B, Miranda D, Soklaridis S, Voineskos AN, Zaheer J. Patient, family and provider views of measurement-based care in an early-psychosis intervention programme. BJPsych Open 2021. [PMCID: PMC8485347 DOI: 10.1192/bjo.2021.1005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background
Measurement-based care (MBC) in mental health improves patient outcomes and is a component of many national guidelines for mental healthcare delivery. Nevertheless, MBC is not routinely integrated into clinical practice. Several known reasons for the lack of integration exist but one lesser explored variable is the subjective perspectives of providers and patients about MBC. Such perspectives are critical to understand facilitators and barriers to improve the integration of MBC into routine clinical practice.
Aims
This study aimed to uncover the perspectives of various stakeholders towards MBC within a single treatment centre.
Method
Researchers conducted qualitative semi-structured interviews with patients (n = 15), family members (n = 7), case managers (n = 8) and psychiatrists (n = 6) engaged in an early-psychosis intervention programme. Data were analysed using thematic analysis, informed by critical realist theory.
Results
Analysis converged on several themes. These include (a) implicit negative assumptions; (b) relevance and utility to practice; (c) equity versus flexibility; and (d) shared decision-making. Providers assumed patients’ perspectives of MBC were negative. Patients’ perspectives of MBC were actually favourable, particularly if MBC was used as an instrument to engage patients in shared decision-making and communication rather than as a dogmatic and rigid clinical decision tool.
Conclusions
This qualitative study presents the views of various stakeholders towards MBC, providing an in-depth examination of the barriers and facilitators to MBC through qualitative investigation. The findings from this study should be used to address the challenges organisations have experienced in implementing MBC.
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Gaine GS, Nealis LJ, Zhou H, Purdon SE, Abba-Aji A. Identification of psychiatric inpatient recovery trajectories using routine outcome monitoring with emerging adults. Psychiatry Res 2021; 302:114000. [PMID: 34051677 DOI: 10.1016/j.psychres.2021.114000] [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: 10/22/2019] [Accepted: 05/07/2021] [Indexed: 11/16/2022]
Abstract
Early intervention for emerging adults with addiction and mental health disorders is beneficial for long-term recovery. The present study investigated the utility of routine outcome monitoring during acute inpatient hospitalization for identifying emerging adults at risk of poor outcomes. This is a retrospective study using latent class growth analysis (LCGA) to identify patient groups with different recovery trajectories, with additional analyses to clarify the characteristics of these trajectory groups. The results identified four patient groups: Rapid responders (38%), gradual responders (34%), high distress non-responders (9%), and low distress non-responders (19%). The high distress non-responding group is characterized by behaviours and disorders associated with ambivalent care seeking: Voluntary admission, longer length of stay, lower service satisfaction, higher outpatient service utilization, elevated risk of emergency department presentation and hospital readmission, and depression/personality disorder diagnosis. The low distress group is characterized by behaviours and disorders associated with treatment rejection: Involuntary admission, shorter length of stay, reduced post-discharge service utilization, and psychotic disorder diagnosis. The results have implications for identifying at-risk youth and developing stepped-care models for more effective and efficient inpatient care.
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Affiliation(s)
- Graham S Gaine
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada; Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Alberta Health Services, Addiction and Mental Health, Edmonton, Alberta, Canada.
| | - Logan J Nealis
- Alberta Health Services, Addiction and Mental Health, Edmonton, Alberta, Canada
| | - Hansen Zhou
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Scot E Purdon
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Alberta Health Services, Addiction and Mental Health, Edmonton, Alberta, Canada
| | - Adam Abba-Aji
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Alberta Health Services, Addiction and Mental Health, Edmonton, Alberta, Canada
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de Jong K, Conijn JM, Gallagher RAV, Reshetnikova AS, Heij M, Lutz MC. Using progress feedback to improve outcomes and reduce drop-out, treatment duration, and deterioration: A multilevel meta-analysis. Clin Psychol Rev 2021; 85:102002. [PMID: 33721605 DOI: 10.1016/j.cpr.2021.102002] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/04/2021] [Accepted: 02/23/2021] [Indexed: 01/08/2023]
Abstract
Progress feedback is an intervention aimed at enhancing patient outcomes in routine clinical practice. This study reports a comprehensive multilevel meta-analysis on the effectiveness of progress feedback in psychological treatments in curative care. The short- and long-term effects of feedback on symptom reduction were investigated using 58 (randomized and non-randomized) studies, analyzing 110 effect sizes in a total of 21,699 patients. Effects of feedback on dropout rate, percentage of deteriorated cases, and treatment duration were also examined. Moderation analyses were conducted for study and feedback characteristics. A small significant effect of progress feedback on symptom reduction (d = 0.15, 95% CI: [0.10, 0.20]) was found, compared to control groups. This was also true for not-on-track cases (d = 0.17, 95% CI: [0.11, 0.22]). In addition, feedback had a small favorable effect on dropout rates (OR = 1.19, 95% CI: [1.03, 1.38]). The moderation analyses identified several potentially interesting variables for further research, including feedback instrument, outcome instrument, type of feedback, feedback frequency, treatment intensity, and country in which the study was conducted. Future studies should report on these variables more consistently so that we can obtain a better understanding of when and why feedback improves outcomes.
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Affiliation(s)
- Kim de Jong
- Institute of Psychology, Leiden University, Leiden, the Netherlands.
| | - Judith M Conijn
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | | | | | - Marya Heij
- Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Miranda C Lutz
- Institute of Psychology, Leiden University, Leiden, the Netherlands; Department of Psychology, Education & Child Studies, Erasmus University, Rotterdam, the Netherlands
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9
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Kazdin AE. Single-case experimental designs: Characteristics, changes, and challenges. J Exp Anal Behav 2020; 115:56-85. [PMID: 33205436 DOI: 10.1002/jeab.638] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/14/2020] [Accepted: 10/05/2020] [Indexed: 01/16/2023]
Abstract
Tactics of Scientific Research (Sidman, 1960) provides a visionary treatise on single-case designs, their scientific underpinnings, and their critical role in understanding behavior. Since the foundational base was provided, single-case designs have proliferated especially in areas of application where they have been used to evaluate interventions with an extraordinary range of clients, settings, and target foci. This article highlights core features of single-case experimental designs, how key and ancillary features of the designs have evolved, the special strengths of the designs, and challenges that have impeded their integration in many areas where their contributions are sorely needed. The article ends by placing the methodological approach in the context of other research traditions. In this way, the discussion moves from the specific designs toward foundations and philosophy of science issues in keeping with the strengths of the person and book we are honoring.
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Prnjak K, Mitchison D, Griffiths S, Mond J, Gideon N, Serpell L, Hay P. Further development of the 12-item EDE-QS: identifying a cut-off for screening purposes. BMC Psychiatry 2020; 20:146. [PMID: 32245441 PMCID: PMC7118929 DOI: 10.1186/s12888-020-02565-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Eating Disorder Examination - Questionnaire Short (EDE-QS) was developed as a 12-item version of the Eating Disorder Examination Questionnaire (EDE-Q) with a 4-point response scale that assesses eating disorder (ED) symptoms over the preceding 7 days. It has demonstrated good psychometric properties at initial testing. The purpose of this brief report is to determine a threshold score that could be used in screening for probable ED cases in community settings. METHODS Data collected from Gideon et al. (2016) were re-analyzed. In their study, 559 participants (80.86% female; 9.66% self-reported ED diagnosis) completed the EDE-Q, EDE-QS, SCOFF, and Clinical Impairment Assessment (CIA). Discriminatory power was compared between ED instruments using receiver operating characteristic (ROC) curve analyses. RESULTS A score of 15 emerged as the threshold that ensured the best trade-off between sensitivity (.83) and specificity (.85), and good positive predictive value (.37) for the EDE-QS, with discriminatory power comparable to other ED instruments. CONCLUSION The EDE-QS appears to be an instrument with good discriminatory power that could be used for ED screening purposes.
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Affiliation(s)
- Katarina Prnjak
- School of Medicine, Western Sydney University, Sydney, Australia.
| | - Deborah Mitchison
- grid.1029.a0000 0000 9939 5719School of Medicine, Western Sydney University, Sydney, Australia ,grid.1004.50000 0001 2158 5405Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Scott Griffiths
- grid.1008.90000 0001 2179 088XPhysical Appearance Research Team, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Jonathan Mond
- grid.1029.a0000 0000 9939 5719School of Medicine, Western Sydney University, Sydney, Australia ,grid.1009.80000 0004 1936 826XCentre for Rural Health, University of Tasmania, Launceston, TAS Australia
| | - Nicole Gideon
- grid.451148.dSuffolk Family Focus Psychology Service, Norfolk and Suffolk NHS Foundation Trust, Suffolk, UK
| | - Lucy Serpell
- grid.83440.3b0000000121901201Research Department of Clinical, Educational and Health Psychology, University College London, London, UK ,grid.451079.e0000 0004 0428 0265North East London NHS Foundation Trust, Essex, UK
| | - Phillipa Hay
- grid.1029.a0000 0000 9939 5719School of Medicine, Western Sydney University, Sydney, Australia ,grid.460708.d0000 0004 0640 3353Camden and Campbelltown Hospitals, SWSLHD, Campbelltown, Australia
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11
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Lewis CC, Boyd M, Puspitasari A, Navarro E, Howard J, Kassab H, Hoffman M, Scott K, Lyon A, Douglas S, Simon G, Kroenke K. Implementing Measurement-Based Care in Behavioral Health: A Review. JAMA Psychiatry 2018; 76:324-335. [PMID: 30566197 PMCID: PMC6584602 DOI: 10.1001/jamapsychiatry.2018.3329] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Measurement-based care (MBC) is the systematic evaluation of patient symptoms before or during an encounter to inform behavioral health treatment. Despite MBC's demonstrated ability to enhance usual care by expediting improvements and rapidly detecting patients whose health would otherwise deteriorate, it is underused, with typically less than 20% of behavioral health practitioners integrating it into their practice. This narrative review addresses definitional issues, offers a concrete and evaluable operationalization of MBC fidelity, and summarizes the evidence base and utility of MBC. It also synthesizes the extant literature's characterization of barriers to and strategies for supporting MBC implementation, sustainment, and scale-up. OBSERVATIONS Barriers to implementing MBC occur at multiple levels: patient (eg, concerns about confidentiality breach), practitioner (eg, beliefs that measures are no better than clinical judgment), organization (eg, no resources for training), and system (eg, competing requirements). Implementation science-the study of methods to integrate evidence-based practices such as MBC into routine care-offers strategies to address barriers. These strategies include using measurement feedback systems, leveraging local champions, forming learning collaboratives, training leadership, improving expert consultation with clinical staff, and generating incentives. CONCLUSIONS AND RELEVANCE This narrative review, informed by implementation science, offers a 10-point research agenda to improve the integration of MBC into clinical practice: (1) harmonize terminology and specify MBC's core components; (2) develop criterion standard methods for monitoring fidelity and reporting quality of implementation; (3) develop algorithms for MBC to guide psychotherapy; (4) test putative mechanisms of change, particularly for psychotherapy; (5) develop brief and psychometrically strong measures for use in combination; (6) assess the critical timing of administration needed to optimize patient outcomes; (7) streamline measurement feedback systems to include only key ingredients and enhance electronic health record interoperability; (8) identify discrete strategies to support implementation; (9) make evidence-based policy decisions; and (10) align reimbursement structures.
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Affiliation(s)
- Cara C. Lewis
- Kaiser Permanente Washington Health Research Institute,
Seattle
| | - Meredith Boyd
- Department of Psychology, UCLA (University of California, Los
Angeles)
| | - Ajeng Puspitasari
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester,
Minnesota
| | - Elena Navarro
- Kaiser Permanente Washington Health Research Institute,
Seattle
| | - Jacqueline Howard
- Department of Psychological and Brain Sciences, Indiana University,
Bloomington
| | | | - Mira Hoffman
- Department of Psychology, West Virginia University,
Morgantown
| | - Kelli Scott
- School of Public Health, Brown University, Providence, Rhode
Island
| | - Aaron Lyon
- Department of Psychiatry and Behavioral Sciences, University of
Washington, Seattle
| | - Susan Douglas
- Department of Leadership, Policy and Organizations, Peabody
College, Vanderbilt University, Nashville, Tennessee
| | - Greg Simon
- Kaiser Permanente Washington Health Research Institute,
Seattle
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12
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de Jong K, Segaar J, Ingenhoven T, van Busschbach J, Timman R. Adverse Effects of Outcome Monitoring Feedback in Patients With Personality Disorders: A Randomized Controlled Trial in Day Treatment and Inpatient Settings. J Pers Disord 2018; 32:393-413. [PMID: 28594629 DOI: 10.1521/pedi_2017_31_297] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study aimed to evaluate the differential effect of outcome monitoring feedback to therapists and to patients on outcomes in cluster B, cluster C, and personality disorder not otherwise specified (PD-NOS) patients. Day treatment patients (n = 112) and inpatients (n = 94) were randomly assigned to a feedback to therapist (FbT), feedback to therapist and patient (FbTP), or no feedback (NFb) condition. Feedback was based on weekly administrations of the Outcome Questionnaire-45 (OQ-45). In cluster B and PD-NOS patients FbTP resulted in increased OQ-45 scores during the first 6 months of therapy for not on track (NOT) patients. In cluster C patients, no adverse effects of feedback were found. These results suggest that for certain personality disorder patient groups, providing feedback during treatment may not always be beneficial, although more research is needed to further assess these effects.
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Affiliation(s)
- Kim de Jong
- Institute of Psychology, Leiden University, Leiden, The Netherlands.,Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jaap Segaar
- GGZ Centraal, Expertise Centre for Personality Disorders
| | - Theo Ingenhoven
- Pro Persona, Center for Psychotherapy, Amersfoort, The Netherlands
| | - Jan van Busschbach
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.,De Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands
| | - Reinier Timman
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
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Zeeck A, Herpertz-Dahlmann B, Friederich HC, Brockmeyer T, Resmark G, Hagenah U, Ehrlich S, Cuntz U, Zipfel S, Hartmann A. Psychotherapeutic Treatment for Anorexia Nervosa: A Systematic Review and Network Meta-Analysis. Front Psychiatry 2018; 9:158. [PMID: 29765338 PMCID: PMC5939188 DOI: 10.3389/fpsyt.2018.00158] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/09/2018] [Indexed: 12/17/2022] Open
Abstract
Background: The aim of the study was a systematic review of studies evaluating psychotherapeutic treatment approaches in anorexia nervosa and to compare their efficacy. Weight gain was chosen as the primary outcome criterion. We also aimed to compare treatment effects according to service level (inpatient vs. outpatient) and age group (adolescents vs. adults). Methods:The data bases PubMed, Cochrane Library, Web of Science, Cinahl, and PsychInfo were used for a systematic literature search (until Feb 2017). Search terms were adapted for data base, combining versions of the search terms anorexia, treat*/therap* and controlled trial. Studies were selected using pre-defined in- and exclusion criteria. Data were extracted by two independent coders using piloted forms. Network-meta-analyses were conducted on all RCTs. For a comparison of service levels and age groups, standard mean change (SMC) statistics were used and naturalistic, non-randomized studies included. Results: Eighteen RCTs (trials on adults: 622 participants; trials on adolescents: 625 participants) were included in the network meta-analysis. SMC analyses were conducted with 38 studies (1,164 participants). While family-based approaches dominate interventions for adolescents, individual psychotherapy dominates in adults. There was no superiority of a specific approach. Weight gains were more rapid in adolescents and inpatient treatment. Conclusions: Several specialized psychotherapeutic interventions have been developed and can be recommended for AN. However, adult and adolescent patients should be distinguished, as groups differ in terms of treatment approaches considered suitable as well as treatment response. Future trials should replicate previous findings and be multi-center trials with large sample sizes to allow for subgroup analyses. Patient assessment should include variables that can be considered relevant moderators of treatment outcome. It is desirable to explore adaptive treatment strategies for subgroups of patients with AN. Identifying and addressing maintaining factors in AN remains a major challenge.
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Affiliation(s)
- Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Hans-Christoph Friederich
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Timo Brockmeyer
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Ulrich Hagenah
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universitaet Dresden, Dresden, Germany
| | - Ulrich Cuntz
- Schön Klinik Roseneck, Prien am Chiemsee, Germany
| | - Stephan Zipfel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
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Rubel JA, Zimmermann D, Deisenhofer AK, Müller V, Lutz W. Nutzung von psychometrischem Feedback als empirische Unterstützung des Supervisionsprozesses bei Ausbildungstherapien. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Trotz der gut belegten generellen Wirksamkeit von Psychotherapie wird die Zahl der Patienten, die nicht auf eine Therapie ansprechen oder sich sogar im Verlauf verschlechtern, auf etwa ein Drittel geschätzt. Da Therapeuten im Vergleich zu empirischen Algorithmen weniger gut in der Lage sind negative Entwicklungen zu entdecken oder zu prognostizieren, brauchen sie zusätzliche Unterstützung in Form von kontinuierlichen Rückmeldungen über den Fortschritt ihrer Patienten. Solche Feedbackinterventionen können als empirisch basierte Unterstützung des Supervisions- oder Intervisionsprozesses verstanden werden. Diese Interventionen haben ihre Wirksamkeit zur Reduktion therapeutischer Misserfolge in zahlreichen Einzelstudien und Meta-Analysen wiederholt zeigen können. Fragestellung: Wie nutzen Therapeuten ein solches Feedback in ihrer praktischen Arbeit und in welchem Ausmaß spielen Therapeutenfaktoren dabei eine Rolle? Methode: In der vorliegenden Studie wurden 72 Therapeuten für 648 ihrer Patienten unmittelbar nach der Therapie dazu befragt, wie sie das psychometrische Feedback genutzt haben. Therapeutenunterschiede wurden mittels Mehrebenenmodellen ermittelt. Ergebnisse: Es konnte gezeigt werden, dass Therapeuten für einen Großteil ihrer Patienten das Feedback verwendeten. In etwa einem Drittel der Fälle gab es den Therapeuten den Anstoß zusätzliche Hilfen (z. B. Supervision/Intervision) zu beanspruchen. Ähnlich einer personengestützten Supervision wurde für über die Hälfte der Patienten das Feedback genutzt um therapeutische Interventionen anzupassen. Ob und in welcher Form es genutzt wurde hing jedoch stark von dem Therapeuten ab. Je nach Verwendungsart konnten Therapeutenunterschiede zwischen 27 % und 52 % der Feedbacknutzung erklären. Die Wahrscheinlichkeit, dass Therapeuten die Nutzungsmöglichkeiten des Feedbacks anwendeten war größer, wenn diese angaben im Durchschnitt zufriedener mit den grafischen Rückmeldungen zu sein. Schlussfolgerungen: Diese Ergebnisse machen deutlich, dass es zu einem großen Teil nicht nur vom Therapieverlauf oder den Charakteristika der jeweiligen Patienten abhängt wie Therapeuten das Feedback nutzen, sondern auch von Variablen, die den Therapeuten betreffen.
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Lambert MJ. Maximizing Psychotherapy Outcome beyond Evidence-Based Medicine. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 86:80-89. [PMID: 28183083 DOI: 10.1159/000455170] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 12/17/2016] [Indexed: 11/19/2022]
Abstract
Despite evidence that psychotherapy has a positive impact on psychological disorders, 30% of patients fail to respond during clinical trials, and as many as 65% of patients in routine care leave treatment without a measured benefit. In addition, therapists appear to overestimate positive outcomes in their patients relative to measured outcomes and are particularly poor at identifying patients at risk for a negative outcome. These problems suggest the need for measuring and monitoring patient treatment response over the course of treatment while applying standardized methods of identifying at-risk cases. Computer-assisted methods for measuring, monitoring, identifying potential deteriorators, and providing feedback to clinicians are described along with a model that explains why feedback is likely to be beneficial to patients. The results of 12 clinical trials are summarized and suggest that deterioration rates can be substantially reduced in at-risk cases (from baseline rates of 21% down to 13%) and that recovery rates are substantially increased in this subgroup of cases (from a baseline of 20% up to 35%) when therapists are provided this information. When problem-solving methods are added to feedback, deterioration in at-risk cases is further reduced to 6% while recovery/improvement rates rise to about 50%. It is suggested that the feedback methods become a standard of practice. Such a change in patterns of care can be achieved through minimal modification to routine practice but may require discussions with patients about their clinical progress.
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Assessing Patient Progress in Psychological Therapy Through Feedback in Supervision: the MeMOS* Randomized Controlled Trial (*Measuring and Monitoring clinical Outcomes in Supervision: MeMOS). Behav Cogn Psychother 2017; 45:209-224. [PMID: 28166849 DOI: 10.1017/s1352465817000029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychological therapy services are often required to demonstrate their effectiveness and are implementing systematic monitoring of patient progress. A system for measuring patient progress might usefully 'inform supervision' and help patients who are not progressing in therapy. AIMS To examine if continuous monitoring of patient progress through the supervision process was more effective in improving patient outcomes compared with giving feedback to therapists alone in routine NHS psychological therapy. METHOD Using a stepped wedge randomized controlled design, continuous feedback on patient progress during therapy was given either to the therapist and supervisor to be discussed in clinical supervison (MeMOS condition) or only given to the therapist (S-Sup condition). If a patient failed to progress in the MeMOS condition, an alert was triggered and sent to both the therapist and supervisor. Outcome measures were completed at beginning of therapy, end of therapy and at 6-month follow-up and session-by-session ratings. RESULTS No differences in clinical outcomes of patients were found between MeMOS and S-Sup conditions. Patients in the MeMOS condition were rated as improving less, and more ill. They received fewer therapy sessions. CONCLUSIONS Most patients failed to improve in therapy at some point. Patients' recovery was not affected by feeding back outcomes into the supervision process. Therapists rated patients in the S-Sup condition as improving more and being less ill than patients in MeMOS. Those patients in MeMOS had more complex problems.
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Bowen MM, Lambert MJ, Berkeljon A, Orr TE, Berrett M, Simon W. Effects of feedback-assisted treatment on post-treatment outcome for eating disordered inpatients: A follow-up study. COGENT PSYCHOLOGY 2016. [DOI: 10.1080/23311908.2016.1191119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Megan M. Bowen
- Psychology Department, Brigham Young University, Provo, UT 84602, USA
| | | | - Arjan Berkeljon
- Psychology Department, Brigham Young University, Provo, UT 84602, USA
| | - Tyler E. Orr
- Psychology Department, Brigham Young University, Provo, UT 84602, USA
| | | | - Witold Simon
- Psychology Department, Brigham Young University, Provo, UT 84602, USA
- Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
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Kendrick T, El‐Gohary M, Stuart B, Gilbody S, Churchill R, Aiken L, Bhattacharya A, Gimson A, Brütt AL, de Jong K, Moore M. Routine use of patient reported outcome measures (PROMs) for improving treatment of common mental health disorders in adults. Cochrane Database Syst Rev 2016; 7:CD011119. [PMID: 27409972 PMCID: PMC6472430 DOI: 10.1002/14651858.cd011119.pub2] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Routine outcome monitoring of common mental health disorders (CMHDs), using patient reported outcome measures (PROMs), has been promoted across primary care, psychological therapy and multidisciplinary mental health care settings, but is likely to be costly, given the high prevalence of CMHDs. There has been no systematic review of the use of PROMs in routine outcome monitoring of CMHDs across these three settings. OBJECTIVES To assess the effects of routine measurement and feedback of the results of PROMs during the management of CMHDs in 1) improving the outcome of CMHDs; and 2) in changing the management of CMHDs. SEARCH METHODS We searched the Cochrane Depression Anxiety and Neurosis group specialised controlled trials register (CCDANCTR-Studies and CCDANCTR-References), the Oxford University PROMS Bibliography (2002-5), Ovid PsycINFO, Web of Science, The Cochrane Library, and International trial registries, initially to 30 May 2014, and updated to 18 May 2015. SELECTION CRITERIA We selected cluster and individually randomised controlled trials (RCTs) including participants with CMHDs aged 18 years and over, in which the results of PROMs were fed back to treating clinicians, or both clinicians and patients. We excluded RCTs in child and adolescent treatment settings, and those in which more than 10% of participants had diagnoses of eating disorders, psychoses, substance use disorders, learning disorders or dementia. DATA COLLECTION AND ANALYSIS At least two authors independently identified eligible trials, assessed trial quality, and extracted data. We conducted meta-analysis across studies, pooling outcome measures which were sufficiently similar to each other to justify pooling. MAIN RESULTS We included 17 studies involving 8787 participants: nine in multidisciplinary mental health care, six in psychological therapy settings, and two in primary care. Pooling of outcome data to provide a summary estimate of effect across studies was possible only for those studies using the compound Outcome Questionnaire (OQ-45) or Outcome Rating System (ORS) PROMs, which were all conducted in multidisciplinary mental health care or psychological therapy settings, because both primary care studies identified used single symptom outcome measures, which were not directly comparable to the OQ-45 or ORS.Meta-analysis of 12 studies including 3696 participants using these PROMs found no evidence of a difference in outcome in terms of symptoms, between feedback and no-feedback groups (standardised mean difference (SMD) -0.07, 95% confidence interval (CI) -0.16 to 0.01; P value = 0.10). The evidence for this comparison was graded as low quality however, as all included studies were considered at high risk of bias, in most cases due to inadequate blinding of assessors and significant attrition at follow-up.Quality of life was reported in only two studies, social functioning in one, and costs in none. Information on adverse events (thoughts of self-harm or suicide) was collected in one study, but differences between arms were not reported.It was not possible to pool data on changes in drug treatment or referrals as only two studies reported these. Meta-analysis of seven studies including 2608 participants found no evidence of a difference in management of CMHDs between feedback and no-feedback groups, in terms of the number of treatment sessions received (mean difference (MD) -0.02 sessions, 95% CI -0.42 to 0.39; P value = 0.93). However, the evidence for this comparison was also graded as low quality. AUTHORS' CONCLUSIONS We found insufficient evidence to support the use of routine outcome monitoring using PROMs in the treatment of CMHDs, in terms of improving patient outcomes or in improving management. The findings are subject to considerable uncertainty however, due to the high risk of bias in the large majority of trials meeting the inclusion criteria, which means further research is very likely to have an important impact on the estimate of effect and is likely to change the estimate. More research of better quality is therefore required, particularly in primary care where most CMHDs are treated.Future research should address issues of blinding of assessors and attrition, and measure a range of relevant symptom outcomes, as well as possible harmful effects of monitoring, health-related quality of life, social functioning, and costs. Studies should include people treated with drugs as well as psychological therapies, and should follow them up for longer than six months.
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Affiliation(s)
- Tony Kendrick
- Aldermoor Health Centre, University of SouthamptonPrimary Care and Population Sciences, Faculty of MedicineAldermoor CloseSouthamptonUKSO16 5ST
| | - Magdy El‐Gohary
- Aldermoor Health Centre, University of SouthamptonPrimary Care and Population Sciences, Faculty of MedicineAldermoor CloseSouthamptonUKSO16 5ST
| | - Beth Stuart
- Aldermoor Health Centre, University of SouthamptonPrimary Care and Population Sciences, Faculty of MedicineAldermoor CloseSouthamptonUKSO16 5ST
| | - Simon Gilbody
- University of YorkDepartment of Health SciencesSeebohm Rowntree BuildingYorkUKYO10 5DD
| | - Rachel Churchill
- University of BristolCentre for Academic Mental Health, School of Social and Community MedicineOakfield HouseOakfield GroveBristolUKBS8 2BN
| | - Laura Aiken
- University Hospital SouthamptonSouthamptonUK
| | | | - Amy Gimson
- University of SouthamptonFaculty of MedicineAldermoor Health Centre, Aldermoor CloseSouthamptonUKSO16 5ST
| | - Anna L Brütt
- University Medical Center Hamburg‐EppendorfDepartment of Medical PsychologyHamburgGermany
| | - Kim de Jong
- Leiden UniversityInstitute of PsychologyWassenaarseweg 52LeidenNetherlands2333 AK
| | - Michael Moore
- Aldermoor Health Centre, University of SouthamptonPrimary Care and Population Sciences, Faculty of MedicineAldermoor CloseSouthamptonUKSO16 5ST
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Development and Psychometric Validation of the EDE-QS, a 12 Item Short Form of the Eating Disorder Examination Questionnaire (EDE-Q). PLoS One 2016; 11:e0152744. [PMID: 27138364 PMCID: PMC4854480 DOI: 10.1371/journal.pone.0152744] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 03/18/2016] [Indexed: 11/20/2022] Open
Abstract
Objective The aim of this study was to develop and validate a short form of the Eating Disorder Examination Questionnaire (EDE-Q) for routine, including session by session, outcome assessment. Method The current, 28-item version (6.0) of the EDE-Q was completed by 489 individuals aged 18–72 with various eating disorders recruited from three UK specialist eating disorder services. Rasch analysis was carried out on factors identified by means of principal component analysis, which in combination with expert ratings informed the development of an EDE-Q short form. The shortened questionnaire’s reliability, validity and sensitivity was assessed based on online data collected from students of a UK university and volunteers with a history of eating disorders recruited from a national eating disorders charity aged 18–74 (N = 559). Results A 12-item short form, the Eating Disorder Examination Questionnaire Short (EDE-QS) was derived. The new measure showed high internal consistency (Cronbach’s α = .913) and temporal stability (ICC = .93; p < .001). It was highly correlated with the original EDE-Q (r = .91 for people without ED; r = .82 for people with ED) and other measures of eating disorder and comorbid psychopathology. It was sufficiently sensitive to distinguish between people with and without eating disorders. Discussion The EDE-QS is a brief, reliable and valid measure of eating disorder symptom severity that performs similarly to the EDE-Q and that lends itself for the use of sessional outcome monitoring in treatment and research.
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de Jong K. Challenges in the Implementation of Measurement Feedback Systems. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 43:467-70. [PMID: 26518779 PMCID: PMC4831990 DOI: 10.1007/s10488-015-0697-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This commentary on the articles published in the special section on the development and implementation of measurement feedback systems (MFSs) discusses three challenging themes in the process of MFS implementation: design and planning, organizational context, and sustainability and unintended consequences. It is argued that the implementation of MFSs is complex, but is an important step in improving outcomes in routine care for children and young persons.
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Affiliation(s)
- Kim de Jong
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.
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Gondek D, Edbrooke-Childs J, Fink E, Deighton J, Wolpert M. Feedback from Outcome Measures and Treatment Effectiveness, Treatment Efficiency, and Collaborative Practice: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 43:325-43. [PMID: 26744316 PMCID: PMC4831994 DOI: 10.1007/s10488-015-0710-5] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Due to recent increases in the use of feedback from outcome measures in mental health settings, we systematically reviewed evidence regarding the impact of feedback from outcome measures on treatment effectiveness, treatment efficiency, and collaborative practice. In over half of 32 studies reviewed, the feedback condition had significantly higher levels of treatment effectiveness on at least one treatment outcome variable. Feedback was particularly effective for not-on-track patients or when it was provided to both clinicians and patients. The findings for treatment efficiency and collaborative practice were less consistent. Given the heterogeneity of studies, more research is needed to determine when and for whom feedback is most effective.
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Affiliation(s)
- Dawid Gondek
- Evidence Based Practice Unit, UCL and Anna Freud Centre, 21 Maresfield Gardens, London, NW3 5SU, UK
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, UCL and Anna Freud Centre, 21 Maresfield Gardens, London, NW3 5SU, UK
| | - Elian Fink
- Evidence Based Practice Unit, UCL and Anna Freud Centre, 21 Maresfield Gardens, London, NW3 5SU, UK
| | - Jessica Deighton
- Evidence Based Practice Unit, UCL and Anna Freud Centre, 21 Maresfield Gardens, London, NW3 5SU, UK
| | - Miranda Wolpert
- Evidence Based Practice Unit, UCL and Anna Freud Centre, 21 Maresfield Gardens, London, NW3 5SU, UK.
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Lutz W, Rubel J, Schiefele AK, Zimmermann D, Böhnke JR, Wittmann WW. Feedback and therapist effects in the context of treatment outcome and treatment length. Psychother Res 2015. [DOI: 10.1080/10503307.2015.1053553] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Amble I, Gude T, Ulvenes P, Stubdal S, Wampold BE. How and when feedback works in psychotherapy: Is it the signal? Psychother Res 2015; 26:545-55. [DOI: 10.1080/10503307.2015.1053552] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Connolly Gibbons MB, Kurtz JE, Thompson DL, Mack RA, Lee JK, Rothbard A, Eisen SV, Gallop R, Crits-Christoph P. The effectiveness of clinician feedback in the treatment of depression in the community mental health system. J Consult Clin Psychol 2015; 83:748-59. [PMID: 26052874 DOI: 10.1037/a0039302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We describe the development and evaluation of a clinician feedback intervention for use in community mental health settings. The Community Clinician Feedback System (CCFS) was developed in collaboration with a community partner to meet the needs of providers working in such community settings. METHOD The CCFS consists of weekly performance feedback to clinicians, as well as a clinical feedback report that assists clinicians with patients who are not progressing as expected. Patients in the randomized sample (N = 100) were predominantly female African Americans, with a mean age of 39 years. RESULTS Satisfaction ratings of the CCFS indicate that the system was widely accepted by clinicians and patients. A hierarchical linear models (HLM) analysis comparing rates of change across conditions controlling for baseline gender, age, and racial group indicated a moderate effect in favor of the feedback condition for symptom improvement, t(94) = 2.41, p = .017, d = .50. Thirty-six percent of feedback patients compared with only 13% of patients in the no-feedback condition demonstrated clinically significant change across treatment, χ2(1) = 6.13, p = .013. CONCLUSIONS These results indicate that our CCFS is acceptable to providers and patients of mental health services and has the potential to improve the effectiveness of services for clinically meaningful depression in the community mental health setting.
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Affiliation(s)
| | | | | | - Rachel A Mack
- Department of Psychiatry, University of Pennsylvania
| | | | | | - Susan V Eisen
- Department of Health Policy and Management, Boston University
| | - Robert Gallop
- Department of Psychiatry, University of Pennsylvania
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Davidson K, Perry A, Bell L. Would continuous feedback of patient's clinical outcomes to practitioners improve NHS psychological therapy services? Critical analysis and assessment of quality of existing studies. Psychol Psychother 2015; 88:21-37. [PMID: 24850588 DOI: 10.1111/papt.12032] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 04/01/2014] [Accepted: 04/10/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE Continuous outcome monitoring studies have been conducted by one group of researchers in the United States, mainly in university counselling clinics. We completed a systematic review of continuous outcome monitoring and feedback during psychological therapy and assessed the quality and methodological rigour of existing studies to examine if the findings might be applicable to psychological therapy settings in the United Kingdom. METHODS An electronic database literature search was carried out on studies on or after 1990 to June 2013 using strict research criteria. Independent ratings of the quality of existing studies were undertaken. RESULTS Ten studies with original data met inclusion criteria and two meta-analyses. Feedback improves outcomes for clients who are at risk of treatment failure but effect sizes diminish with more severe psychiatric populations. No study has followed up patients to assess maintenance of gains. Study quality is highly variable. Few studies included diagnostic information and details of randomization. Clinical Support Tools are thought to be helpful but how these were used was not described. CONCLUSIONS Although research in continuous monitoring and feedback of clinical outcomes shows promising results in counselling settings, study quality, and methodological issues set limitations on the generalizability of the findings. PRACTITIONER POINTS Feedback improves the outcome of therapy for young people with mild problems for those who are at risk of not improving with therapy. Feedback improves outcomes for those with more severe mental health problems but with reduced effect sizes. We do not know if improved outcomes are sustained. The generalizability of the findings may be limited.
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Affiliation(s)
- Kate Davidson
- Institute of Health and Wellbeing, University of Glasgow, UK
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Dyer K, Hooke GR, Page AC. Effects of providing domain specific progress monitoring and feedback to therapists and patients on outcome. Psychother Res 2014; 26:297-306. [DOI: 10.1080/10503307.2014.983207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Amble I, Gude T, Stubdal S, Andersen BJ, Wampold BE. The effect of implementing the Outcome Questionnaire-45.2 feedback system in Norway: A multisite randomized clinical trial in a naturalistic setting. Psychother Res 2014; 25:669-77. [DOI: 10.1080/10503307.2014.928756] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Evaluating reliable and clinically significant change in eating disorders: comparisons to changes in DSM-IV diagnoses. Psychiatry Res 2014; 216:248-54. [PMID: 24582504 DOI: 10.1016/j.psychres.2014.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 01/31/2014] [Accepted: 02/05/2014] [Indexed: 11/20/2022]
Abstract
Assessing clinically meaningful change is valuable for treatment planning, monitoring course of illness and evaluating outcome. Although DSM eating disorder (ED) diagnoses have been criticized for poor clinical utility, instability, and uncertainty, remission/change of diagnosis is often the standard for evaluating outcome. We tested the validity of the clinically significant reliable change index (CS/RCI) compared to change in DSM-IV ED-diagnoses. We investigated if CS/RCI was concordant to diagnostic change and compared explained variance on measures at follow-up. Using a database for specialized ED treatment in Sweden the sample contained 1042 female patients (246 adolescents/796 adults). CS/RCI was calculated for the Clinical Impairment Assessment (CIA) and the Eating Disorder Examination Questionnaire (EDE-Q). CS/RCI explained more variance in gain scores for psychopathology measures than diagnostic change (DSM-IV). Average agreement between diagnostic change and CS/RCI was 62% and 60% for CIA and EDE-Q, respectively. Diagnostic change always resulted in more positive outcome than CS/RCI. Together with clinical judgment, CS/RCI is a valuable method for determining clinically significant changes in clinical practice and research. It is economically sound and results are easily interpreted and communicated to patients.
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Davidsen AH, Poulsen S, Waaddegaard M, Lindschou J, Lau M. Feedback versus no feedback in improving patient outcome in group psychotherapy for eating disorders (F-EAT): protocol for a randomized clinical trial. Trials 2014; 15:138. [PMID: 24754974 PMCID: PMC4005398 DOI: 10.1186/1745-6215-15-138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 04/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Continuous feedback on patient improvement and the therapeutic alliance may reduce the number of dropouts and increase patient outcome. There are, however, only three published randomized trials on the effect of feedback on the treatment of eating disorders, showing inconclusive results, and there are no randomized trials on the effect of feedback in group therapy. Accordingly the current randomized clinical trial, initiated in September 2012 at the outpatient clinic for eating disorders at Stolpegaard Psychotherapy Centre, aims to investigate the impact of continuous feedback on attendance and outcome in group psychotherapy. METHODS/DESIGN The hypothesis is that continuous feedback to both patient and therapist on treatment progress and alliance will increase attendance and treatment outcome. The trial is set up using a randomized design with a minimum of 128 patients allocated to either an experimental or control group at a ratio of 1:1. The experimental group will receive standard treatment (systemic and narrative group psychotherapy) with feedback intervention, whereas the control group will receive standard treatment only. The participants are diagnosed with bulimia nervosa, binge eating disorder, or an eating disorder not otherwise specified, according to the DSM-IV. In the experimental group feedback to the participants, based on the Outcome Rating Scale (ORS) and the Group Session Rating Scale (GSRS), is actively added to standard treatment. The ORS assesses areas of life functioning known to change as a result of therapeutic intervention. The GSRS assesses key dimensions of effective therapeutic relationships. In the control group, the patients fill out the Outcome Rating Scale only, and feedback is not provided.The primary outcome is the rate of attendance to treatment sessions. The secondary outcome is the severity of eating disorder symptoms. Exploratory outcomes are the level of psychological and social functioning, and suicide or self-harm. This is measured with the ORS, Symptom Check List, WHO-Five Wellbeing Index, Sheehan Disability Scale and a modified version of the Self-Harm Inventory. DISCUSSION If the results will confirm the hypothesis, this trial will support feedback as a way to improve group treatment attendance for outpatients with eating disorders. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01693237.
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Affiliation(s)
- Annika Helgadóttir Davidsen
- Stolpegaard Psychotherapy Centre, Stolpegaardsvej 20, Gentofte 2820, Denmark
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, Copenhagen K 1353, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, Copenhagen K 1353, Denmark
| | - Mette Waaddegaard
- Stolpegaard Psychotherapy Centre, Stolpegaardsvej 20, Gentofte 2820, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, OE 2100, Denmark
| | - Marianne Lau
- Stolpegaard Psychotherapy Centre, Stolpegaardsvej 20, Gentofte 2820, Denmark
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De Jong K, Timman R, Hakkaart-Van Roijen L, Vermeulen P, Kooiman K, Passchier J, Busschbach JV. The effect of outcome monitoring feedback to clinicians and patients in short and long-term psychotherapy: A randomized controlled trial. Psychother Res 2014; 24:629-39. [DOI: 10.1080/10503307.2013.871079] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Probst T, Lambert MJ, Loew TH, Dahlbender RW, Göllner R, Tritt K. Feedback on patient progress and clinical support tools for therapists: improved outcome for patients at risk of treatment failure in psychosomatic in-patient therapy under the conditions of routine practice. J Psychosom Res 2013; 75:255-61. [PMID: 23972415 DOI: 10.1016/j.jpsychores.2013.07.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 07/02/2013] [Accepted: 07/06/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Although psychosomatic in-patient treatment is effective, 5-10% of the patients deteriorate. Providing patient progress feedback and clinical support tools to therapists improves the outcome for patients at risk of deterioration in counseling, outpatient psychotherapy, and substance abuse treatment. This study investigated the effects of feedback on psychosomatically treated in-patients at risk of treatment failure. METHODS At intake, all patients of two psychosomatic clinics were randomized either into the experimental group or the treatment-as-usual control group. Both groups were tracked weekly with the "Outcome Questionnaire" (OQ-45) measuring patient progress and with the clinical support tool "Assessment of Signal Cases" (ASC). Therapists received feedback from both instruments for all their experimental group patients. "Patients at risk" were defined as patients who deviated from expected recovery curves by at least one standard deviation. Of 252 patients, 43 patients were at risk: 23 belonged to the experimental group, 20 to the control group. The feedback effect was analyzed using a level-2-model for discontinuous change, effect size (d), reliable change index (RCI), and odds ratio for reliable deterioration. RESULTS For patients at risk, the experimental group showed an improved outcome on the OQ-45 total scale compared to the control group (p<0.05, d=0.54). By providing feedback, the rate of reliably deteriorated patients at risk was reduced from 25.0% (control group) to 8.7% (experimental group) - odds ratio=0.29. All reliably improved patients at risk belonged to the experimental group. CONCLUSION Feedback improves the outcome of patients at risk undergoing psychosomatic in-patient treatment.
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Affiliation(s)
- Thomas Probst
- University Clinic of Regensburg, Department of Psychosomatics, Germany
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Tasca GA, Machado PP. Eating disorder psychotherapy research – beyond the brand: Introduction to a Special Section. Psychother Res 2013; 23:247-51. [DOI: 10.1080/10503307.2013.796425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Chapman CL, Burlingame GM, Gleave R, Rees F, Beecher M, Porter GS. Clinical prediction in group psychotherapy. Psychother Res 2012; 22:673-81. [DOI: 10.1080/10503307.2012.702512] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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