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Szota K, van der Meer AS, Bourdeau T, Chorpita BF, Chavanon ML, Christiansen H. Pilot study of implementing Managing and Adapting Practice in a German psychotherapy master's program. Sci Rep 2024; 14:16466. [PMID: 39014099 PMCID: PMC11252301 DOI: 10.1038/s41598-024-67407-w] [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: 11/26/2023] [Accepted: 07/10/2024] [Indexed: 07/18/2024] Open
Abstract
Despite a significant accumulation of research, there has been little systemic implementation of evidence-based practices (EBP) in youth mental health care. The fragmentation of the evidence base complicates implementation efforts. In light of this challenge, we sought to pilot a system that consolidates and coordinates the entire evidence base in a single direct service model (i.e., Managing and Adapting Practice; MAP) in the context of a legal reform of psychotherapy training in Germany. This pilot study aimed to evaluate the feasibility of the implementation of MAP into the curriculum of the reformed German master's program. Eligible participants were students in the master's program at Philipps-University Marburg during the winter-term 2022/2023. Students first learned about MAP through introductions and role plays (seminar 1), followed by actively planning and conducting interventions using MAP resources for patients in a case seminar under supervision (seminar 2). A repeated-measures survey was conducted to investigate students' knowledge gains, perception of MAP and changes in their self-rated confidence to use EBP. Results indicated that students perceive MAP to be manageable to learn. Positive progress was achieved with regard to their knowledge and self-reported confidence to use EBP, although interpretation and generalization of the results are limited by small and homogeneous samples, lack of statistical power and missing comparison groups. The feasibility of the implementation and suitability of measures are discussed. Important implications could be drawn with regard to future investigations.
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Affiliation(s)
- Katharina Szota
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany.
- Department of Psychology, Goethe-University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt am Main, Germany.
| | - Anna S van der Meer
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany
| | - Teri Bourdeau
- PracticeWise, PO Box 372657, Satellite Beach, FL, 32937, USA
| | - Bruce F Chorpita
- UCLA Department of Psychology, 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Mira-Lynn Chavanon
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany
| | - Hanna Christiansen
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany
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Ragnarsson EH, Reinebo G, Ingvarsson S, Lindgren A, Beckman M, Alfonsson S, Hedman-Lagerlöf M, Rahm C, Sahlin H, Stenfors T, Sörman K, Jansson-Fröjmark M, Lundgren T. Effects of Training in Cognitive Behavioural Therapy and Motivational Interviewing on Mental Health Practitioner Behaviour: A Systematic Review and Meta-Analysis. Clin Psychol Psychother 2024; 31:e3003. [PMID: 38855846 DOI: 10.1002/cpp.3003] [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: 03/19/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 06/11/2024]
Abstract
Effective training of mental health professionals is crucial for bridging the gap between research and practice when delivering cognitive behavioural therapy (CBT) and motivational interviewing (MI) within community settings. However, previous research has provided inconclusive evidence regarding the impact of training efforts. The current study aimed to systematically search, review and synthesize the literature on CBT and MI training to assess its effect on practitioner behavioural outcomes. Following prospective registration, a literature search was conducted for studies where mental health practitioners were exposed to training in face-to-face CBT or MI, reporting on at least one quantitative practitioner behavioural outcome. A total of 116 studies were eligible for the systematic review, and 20 studies were included in four meta-analyses. The systematic review highlights the need to establish psychometrically valid outcome measures for practitioner behaviour. Results of the meta-analyses suggest that training has a greater effect on practitioner behaviour change compared to receiving no training or reading a treatment manual. Training combined with consultation/supervision was found to be more effective than training alone, and no differences were found between face-to-face and online training. Results should be interpreted with caution due to methodological limitations in the primary studies, large heterogeneity, and small samples in the meta-analyses. Future directions are discussed.
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Affiliation(s)
- Emma Högberg Ragnarsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Gustaf Reinebo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Sara Ingvarsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Annika Lindgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Maria Beckman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Sven Alfonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Maria Hedman-Lagerlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Christoffer Rahm
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Hanna Sahlin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Karolina Sörman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
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Higa-McMillan CK, Park AL, Daleiden EL, Becker KD, Bernstein A, Chorpita BF. Getting More Out of Clinical Documentation: Can Clinical Dashboards Yield Clinically Useful Information? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:268-285. [PMID: 38261119 DOI: 10.1007/s10488-023-01329-z] [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] [Accepted: 11/29/2023] [Indexed: 01/24/2024]
Abstract
This study investigated coded data retrieved from clinical dashboards, which are decision-support tools that include a graphical display of clinical progress and clinical activities. Data were extracted from clinical dashboards representing 256 youth (M age = 11.9) from 128 practitioners who were trained in the Managing and Adapting Practice (MAP) system (Chorpita & Daleiden in BF Chorpita EL Daleiden 2014 Structuring the collaboration of science and service in pursuit of a shared vision. 43(2):323 338. 2014, Chorpita & Daleiden in BF Chorpita EL Daleiden 2018 Coordinated strategic action: Aspiring to wisdom in mental health service systems. 25(4):e12264. 2018) in 55 agencies across 5 regional mental health systems. Practitioners labeled up to 35 fields (i.e., descriptions of clinical activities), with the options of drawing from a controlled vocabulary or writing in a client-specific activity. Practitioners then noted when certain activities occurred during the episode of care. Fields from the extracted data were coded and reliability was assessed for Field Type, Practice Element Type, Target Area, and Audience (e.g., Caregiver Psychoeducation: Anxiety would be coded as Field Type = Practice Element; Practice Element Type = Psychoeducation; Target Area = Anxiety; Audience = Caregiver). Coders demonstrated moderate to almost perfect interrater reliability. On average, practitioners recorded two activities per session, and clients had 10 unique activities across all their sessions. Results from multilevel models showed that clinical activity characteristics and sessions accounted for the most variance in the occurrence, recurrence, and co-occurrence of clinical activities, with relatively less variance accounted for by practitioners, clients, and regional systems. Findings are consistent with patterns of practice reported in other studies and suggest that clinical dashboards may be a useful source of clinical information. More generally, the use of a controlled vocabulary for clinical activities appears to increase the retrievability and actionability of healthcare information and thus sets the stage for advancing the utility of clinical documentation.
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Eiraldi R, Lawson GM, Glick HA, Khanna MS, Beidas R, Fishman J, Rabenau-McDonnell Q, Wilson T, Comly R, Schwartz BS, Jawad AF. Implementation fidelity, student outcomes, and cost-effectiveness of train-the-trainer strategies for Masters-level therapists in urban schools: results from a cluster randomized trial. Implement Sci 2024; 19:4. [PMID: 38273369 PMCID: PMC10809609 DOI: 10.1186/s13012-023-01333-9] [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: 02/02/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Little is known about the effectiveness and cost-effectiveness of train-the-trainer implementation strategies in supporting mental health evidence-based practices in schools, and about the optimal level of support needed for TT strategies. METHODS The current study is part of a larger type 2 hybrid cluster randomized controlled trial. It compares two train-the-trainer strategies, Train-the-Trainer (TT) and Train-the-Trainer plus ongoing consultation for trainers (TT +) on the delivery of a group cognitive behavioral treatment protocol for anxiety disorders. Participants were 33 therapists, 29 supervisors, and 125 students who were at risk for anxiety disorders from 22 urban schools. Implementation outcomes were implementation fidelity and treatment dosage. Student outcomes were child- and parent-reported symptoms of anxiety, child-reported symptoms of depression, and teacher-reported academic engagement. We estimated the cost of implementing the intervention in each condition and examined the probability that a support strategy for supervisors (TT vs TT +) is a good value for varying values of willingness to pay. RESULTS Therapists in the TT and TT + conditions obtained similarly high implementation fidelity and students in the conditions received similar treatment dosages. A mixed effects modeling approach for student outcomes revealed time effects for symptoms of anxiety and depression reported by students, and emotional disaffection reported by teachers. There were no condition or condition × times effects. For both conditions, the time effects indicated an improvement from pre-treatment to post-treatment in symptoms of anxiety and depression and academic emotional engagement. The average cost of therapist, supervisor, and consultant time required to implement the intervention in each condition was $1002 for TT and $1431 for TT + (p = 0.01). There was a greater than 80% chance that TT was a good value compared to TT + for all values of willingness to pay per one-point improvement in anxiety scores. CONCLUSIONS A TT implementation approach consisting of a thorough initial training workshop for therapists and supervisors as well as ongoing supervision for therapists resulted in adequate levels of fidelity and student outcomes but at a lower cost, compared to the TT + condition that also included ongoing external expert consultation for supervisors. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02651402.
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Affiliation(s)
- Ricardo Eiraldi
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA.
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St, Philadelphia, PA, 19104, USA.
| | - Gwendolyn M Lawson
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St, Philadelphia, PA, 19104, USA
| | - Henry A Glick
- Department of Biostatistics and Epidemiology, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA, 19104, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Wharton School, University of Pennsylvania, 3620 Locust Walk, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locus Walk # 210, Philadelphia, PA, 19104, USA
| | - Muniya S Khanna
- OCD and Anxiety Institute, 3138 Butler Pike # 200, Plymouth Meeting, PA, 19462, USA
| | - Rinad Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 North Michigan Avenue, Chicago, IL, 60611, USA
| | - Jessica Fishman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St, Philadelphia, PA, 19104, USA
- Message Effects Lab, Annenberg School for Communication, University of Pennsylvania, 3620 Walnut Street, Philadelphia, PA, 19104, USA
| | - Quinn Rabenau-McDonnell
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
| | - Tara Wilson
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
| | - Rachel Comly
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
| | - Billie S Schwartz
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
| | - Abbas F Jawad
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
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Herschell AD, Kolko DJ, Scudder AT, Taber-Thomas SM, Schaffner KF, Hart JA, Mrozowski SJ, Hiegel SA, Iyengar S, Metzger A, Jackson CB. A Statewide Randomized Controlled Trial to Compare Three Models for Implementing Parent Child Interaction Therapy. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:780-796. [PMID: 34928748 DOI: 10.1080/15374416.2021.2001745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study (NIMH RO1 MH095750; ClinicalTrials.gov Identifier: NCT02543359) evaluated the effectiveness of three training models to implement a well-established evidence-based treatment, Parent-Child Interaction Therapy (PCIT). METHOD Fifty licensed outpatient clinics, including 100 clinicians, 50 supervisors, and 50 administrators were randomized to one of three training conditions: 1) Learning Collaborative (LC), 2) Cascading Model (CM) or 3) Distance Education (DE). Data to assess training and implementation outcomes were collected at 4 time points coinciding with the training period: baseline, 6- (mid), 12- (post), and 24-months (1-year follow-up). RESULTS Multi-level hierarchical linear growth modeling was used to examine changes over time in training outcomes. Results indicate that clinicians in CM were more likely to complete training, reported high levels of training satisfaction and better learning experiences compared to the other training conditions. However, supervisors in the LC condition reported greater learning experiences, higher levels of knowledge, understanding of treatment, and satisfaction compared to supervisors in other conditions. Although clinicians and supervisors in the DE condition did not outperform their counterparts on any outcomes, their performance was comparable to both LC and CM in terms of PCIT use, supervisor perceived acceptability, feasibility, system support, and clinician satisfaction. CONCLUSIONS Through the use of a randomized controlled design and community implementation, this study contributes to the current understanding of the impact of training design on implementation of PCIT. Results also indicate that although in-person training methods may produce more positive clinician and supervisor outcomes, training is not a one-size-fits-all model, with DE producing comparable results on some variables.
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Affiliation(s)
- Amy D Herschell
- Community Care Behavioral Health Organization, UPMC Insurance Services Division
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - David J Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Ashley T Scudder
- Department of Human Development & Family Studies, Iowa State University
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Callaway CA, Sarfan LD, Agnew ER, Dong L, Spencer JM, Hache RE, Diaz M, Howlett SA, Fisher KR, Yates HEH, Stice E, Kilbourne AM, Buysse DJ, Harvey AG. The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 2: study protocol for a hybrid type 2 effectiveness-implementation cluster-randomized trial using train-the-trainer. Trials 2023; 24:503. [PMID: 37550730 PMCID: PMC10408147 DOI: 10.1186/s13063-023-07523-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/17/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Train-the-trainer (TTT) is a promising method for implementing evidence-based psychological treatments (EBPTs) in community mental health centers (CMHCs). In TTT, expert trainers train locally embedded individuals (i.e., Generation 1 providers) to deliver an EBPT, who then train others (i.e., Generation 2 providers). The present study will evaluate implementation and effectiveness outcomes of an EBPT for sleep and circadian dysfunction-the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C)-delivered to CMHC patients with serious mental illness by Generation 2 providers (i.e., trained and supervised within CMHCs via TTT). Specifically, we will investigate whether adapting TranS-C to fit CMHC contexts improves Generation 2 (a) patient outcomes and (b) providers' perceptions of fit. METHODS TTT will be implemented in nine CMHCs in California, USA (N = 60 providers; N = 130 patients) via facilitation. CMHCs are cluster-randomized by county to Adapted TranS-C or Standard TranS-C. Within each CMHC, patients are randomized to immediate TranS-C or usual care followed by delayed treatment with TranS-C (UC-DT). Aim 1 will assess the effectiveness of TranS-C (combined Adapted and Standard), compared to UC-DT, on improvements in sleep and circadian problems, functional impairment, and psychiatric symptoms for Generation 2 patients. Aim 2 will evaluate whether Adapted TranS-C is superior to Standard TranS-C with respect to Generation 2 providers' perceptions of fit. Aim 3 will evaluate whether Generation 2 providers' perceived fit mediates the relation between TranS-C treatment condition and patient outcomes. Exploratory analyses will (1) evaluate whether the effectiveness of TranS-C for patient outcomes is moderated by generation, (2) compare Adapted and Standard TranS-C on patient perceptions of credibility/improvement and PhenX Toolkit outcomes (e.g., substance use, suicidality), and (3) evaluate other possible moderators. DISCUSSION This trial has potential to (a) inform the process of embedding local trainers and supervisors to expand delivery of a promising transdiagnostic treatment for sleep and circadian dysfunction, (b) add to the growing body of TTT literature by evaluating TTT outcomes with a novel treatment and population, and (c) advance our understanding of providers' perceptions of EBPT "fit" across TTT generations. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT05805657 . Registered on April 10, 2023.
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Affiliation(s)
| | | | | | - Lu Dong
- RAND Corporation, Santa Monica, CA, USA
| | | | | | | | | | | | | | | | - Amy M Kilbourne
- University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Hogue A, Bobek M, Porter N, Dauber S, Southam-Gerow MA, McLeod BD, Henderson CE. Core Elements of Family Therapy for Adolescent Behavioral Health Problems: Validity Generalization in Community Settings. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:490-502. [PMID: 34519608 PMCID: PMC8918434 DOI: 10.1080/15374416.2021.1969939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The core elements of family therapy for adolescent mental health and substance use problems, originally distilled from high-fidelity sessions conducted by expert clinicians, were tested for validity generalization when delivered by community therapists in routine settings. METHOD The study sampled recorded sessions from 161 cases participating in one of three treatment pools: implementation trial of Functional Family Therapy (98 sessions/50 cases/22 therapists), adaptation trial of Multisystemic Therapy (115 sessions/59 cases/2 therapists), and naturalistic trial of non-manualized family therapy in usual care (107 sessions/52 cases/21 therapists). Adolescents were identified as 60% male and 40% female with an average age of 15.4 years; 49% were Latinx, 27% White Non-Latinx, 15% African American, 3% another race/ethnicity, 6% race/ethnicity unknown. Session recordings (n = 320) were randomly selected for each case and coded for 21 discrete family therapy techniques. Archived data of one-year clinical outcomes were gathered. RESULTS Confirmatory factor analyses replicated the factor structure from the original distillation study, retaining all four clinically coherent treatment modules comprised of all 21 techniques: Interactional Change (ICC = .77, Cronbach's α = .81); Relational Reframe (ICC = .75, α = .81); Adolescent Engagement (ICC = .72, α = .78); Relational Emphasis (ICC = .76, α = .80). Exploratory analyses found that greater use of core techniques predicted symptom improvements in one treatment pool. CONCLUSIONS Core techniques of family therapy distilled from manualized treatments for adolescent behavioral health problems showed strong evidence of validity generalization, and initial evidence of links to client outcomes, in community settings.
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Affiliation(s)
- Aaron Hogue
- Partnership to End Addiction, 485 Lexington Avenue, 3 floor, New York, NY 10017, USA
| | - Molly Bobek
- Partnership to End Addiction, 485 Lexington Avenue, 3 floor, New York, NY 10017, USA
| | - Nicole Porter
- Partnership to End Addiction, 485 Lexington Avenue, 3 floor, New York, NY 10017, USA
| | - Sarah Dauber
- Partnership to End Addiction, 485 Lexington Avenue, 3 floor, New York, NY 10017, USA
| | | | | | - Craig E. Henderson
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA
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Callaway CA, Sarfan LD, Agnew ER, Dong L, Spencer JM, Hache RE, Diaz M, Howlett SA, Fisher KR, Yates HEH, Stice E, Kilbourne AM, Buysse DJ, Harvey AG. The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 2: Study protocol for a hybrid type 2 effectiveness-implementation cluster- randomized trial using train-the-trainer. RESEARCH SQUARE 2023:rs.3.rs-2943787. [PMID: 37398014 PMCID: PMC10312945 DOI: 10.21203/rs.3.rs-2943787/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background Train-the-trainer (TTT) is a promising method for implementing evidence-based psychological treatments (EBPTs) in community mental health centers (CMHCs). In TTT, expert trainers train locally embedded individuals (i.e., Generation 1 providers) to deliver an EBPT, who then train others (i.e., Generation 2 providers). The present study will evaluate implementation and effectiveness outcomes of an EBPT for sleep and circadian dysfunction-the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C)-delivered to CMHC patients with serious mental illness by Generation 2 providers (i.e., trained and supervised within CMHCs via TTT). Specifically, we will investigate whether adapting TranS-C to fit CMHC contexts improves Generation 2 (a) patient outcomes (b) providers' perceptions of fit. Methods TTT will be implemented in nine CMHCs in California, United States (N= 60 providers; N= 130 patients) via facilitation. CMHCs are cluster-randomized by county to Adapted TranS-C or Standard TranS-C. Within each CMHC, patients are randomized to immediate TranS-C or usual care followed by delayed treatment with TranS-C (UC-DT). Aim 1 will assess the effectiveness of TranS-C (combined Adapted and Standard), compared to UC-DT, on improvements in sleep and circadian problems, functional impairment, and psychiatric symptoms for Generation 2 patients. Aim 2 will evaluate whether Adapted TranS-C is superior to Standard TranS-C with respect to Generation 2 providers' perceptions of fit. Aim 3 will evaluate whether Generation 2 providers' perceived fit mediates the relation between TranS-C treatment condition and patient outcomes. Exploratory analyses will: (1) evaluate whether the effectiveness of TranS-C for patient outcomes is moderated by generation, (2) compare Adapted and Standard TranS-C on patient perceptions of credibility/improvement and PhenX Toolkit outcomes (e.g., substance use, suicidality); and (3) evaluate other possible moderators. Discussion This trial has potential to inform the process of (a) embedding local trainers and supervisors to expand delivery of a promising transdiagnostic treatment for sleep and circadian dysfunction, (b) adding to the growing body of TTT literature by evaluating TTT outcomes with a novel treatment and population, and (c) advancing our understanding of providers' perceptions of EBPT 'fit' across TTT generations. Trial registration Clinicaltrials.gov identifier: NCT05805657. Registered on April 10, 2023. https://clinicaltrials.gov/ct2/show/NCT05805657.
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Becker KD, Chorpita BF. Future Directions in Youth and Family Treatment Engagement: Finishing the Bridge Between Science and Service. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:284-309. [PMID: 36787342 DOI: 10.1080/15374416.2023.2169926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The field has spent more than 50 years investing in the quality of youth mental healthcare, with intervention science yielding roughly 1,300 efficacious treatments. In the latter half of this period, concurrent efforts in implementation science have developed effective methods for supporting front-line service organizations and therapists to begin to bridge the science to service gap. However, many youths and families still do not benefit fully from these strategic investments due to low treatment engagement: nearly half of youths in need of services pursue them, and among those who do, roughly another half terminate prematurely. The negative impact of low engagement is substantial, and is disproportionally and inequitably so for many. We contend that to build a robust and "finished" bridge connecting science and service, the field must go beyond its two historical foci of designing interventions and preparing therapists to deliver them, to include an intentional focus on the youths and families who participate in these interventions and who work with those therapists. In this paper, we highlight the significance of treatment engagement in youth mental healthcare and discuss the current state of the literature related to four priorities: conceptualization, theory, measurement, and interventions. Next, we offer an example from our own program of research as one illustration for advancing these priorities. Finally, we propose recommendations to act on these priorities.
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Cho E, Tugendrajch SK, McMillen JC, Proctor EK, Hawley KM. Implementation of Evidence-Based Practices within Treatment-As-Usual and Evidence-Based Practice Initiatives. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:757-784. [PMID: 35501585 PMCID: PMC11003240 DOI: 10.1007/s10488-022-01197-z] [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] [Subscribe] [Scholar Register] [Accepted: 04/03/2022] [Indexed: 11/25/2022]
Abstract
Publicly funded initiatives are underway to improve implementation of evidence-based practices (EBP) in youth mental health services. However, we know little about the success of these initiatives or about EBP implementation independent of such initiatives. We examined EBP implementation in a treatment as usual (TAU) state and in six states with publicly funded EBP initiatives (EBPIs). In Study 1, we examined providers' use of practices derived from the evidence base (PDEB) and their predictors among 780 providers in a TAU state. In Study 2, we conducted a systematic review of implementation strategies, outcomes, and predictors of EBP use in six state funded EBPIs. Study 1 suggests TAU providers use PDEB alongside practices without consistent research support; provider racial/ethnic minority status, learning theory orientation, and manual use predict greater PDEB use. Study 2 indicates EBPIs employ multiple recommended implementation strategies with variable outcomes across studies and measurement approaches. Predictors of EBP use in EBPIs also varied, though training, setting, and youth age were consistent predictors across studies. While sample differences and inconsistent measurement across studies made direct comparisons somewhat tenuous, rates of PDEB use in the TAU sample appeared similar to those in publicly funded EBPIs. However, two states reported comparisons with TAU samples and found higher EBP implementation under EBPI. Different predictors impacted EBP use in TAU versus EBPIs. Our findings highlight the need for improved evaluation of EBPIs including clear reporting standards for outcomes and more consistent, standardized measurement of EBP use in order to better understand and improve EBPIs.
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Affiliation(s)
- E Cho
- Harvard University, 33 Kirkland St, Cambridge, MA, 02138, USA
| | - S K Tugendrajch
- University of Missouri, 200 South 7th Street, Columbia, MO, 65211, USA
| | - J C McMillen
- University of Chicago, 969 E. 60th Street, Chicago, IL, 60637, USA
| | - E K Proctor
- Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - K M Hawley
- University of Missouri, 204C McAlester Hall, Columbia, MO, 65211, USA.
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11
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Sibley MH, Ortiz M, Rios-Davis A, Zulauf-McCurdy CA, Graziano PA, Bickman L. Stakeholder-Generated Implementation Strategies to Promote Evidence-Based ADHD Treatment in Community Mental Health. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:44-58. [PMID: 33988847 DOI: 10.1007/s10488-021-01143-5] [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] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Community implementation of evidence-based practices (EBPs) for Attention Deficit/Hyperactivity Disorder (ADHD) is greatly lacking. A recent randomized community-based trial of an EBP for ADHD (Supporting Teens' Autonomy Daily; STAND) demonstrated suboptimal implementation and effectiveness outcomes. In the present study, we conducted an Innovation Tournament (IT) with agency staff stakeholders (N = 26) to identify barriers to successful implementation of STAND and implementation strategies for a revised service delivery model. We conducted member-checking of agency staff-generated ideas with parents (N = 226) and subsequent querying of additional parent (N = 226) and youth-generated (N = 205) strategies to improve care. Go-Zone plots were utilized to identify strategies with the highest feasibility and importance. Practical barriers (i.e., transportation, scheduling difficulties) and parent/youth engagement were the most commonly cited obstacles to successful implementation of STAND in community contexts. Eighteen "winning" implementation strategies were identified that survived member checking. These were classified as train and educate stakeholders (n = 5; e.g., train agency supervisors to deliver supervision, digitize treatment materials and trainings), engage consumers (n = 9; e.g., begin treatment with rapport building sessions, increase psychoeducation), provide interactive assistance (n = 2; e.g., add group supervision, increase roleplay in supervision), and use of evaluative/iterative strategies (n = 2; e.g., perform fidelity checks, supervisor review of session recordings). Parents and youth desired longer duration of treatment and increased focus on maintenance. Strategies will be developed and tested as part of a pilot effectiveness trial designed to refine STAND's service delivery model.Trial Registration NCT02694939 www.clinicaltrials.gov.
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Affiliation(s)
- Margaret H Sibley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
- Seattle Children's Research Institute, Seattle, WA, USA.
| | | | | | - Courtney A Zulauf-McCurdy
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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12
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Walker SC, Gubner N, Iztguttinov A, Rodriguez F, Davis P, Lyon A, Kerns S, Bruns E, Qian J, Sedlar G. The implementation potential of a method to monitor empirically-supported children's mental health treatment through claims data. BMC Health Serv Res 2021; 21:1349. [PMID: 34922540 PMCID: PMC8684062 DOI: 10.1186/s12913-021-07317-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background The delivery of evidence-supported treatments (EST) in children’s mental health could be a valuable measure for monitoring mental healthcare quality; however, efforts to monitor the use of EST in real world systems are hindered by the lack of pragmatic methods. This mixed methods study examined the implementation and agency response rate of a pragmatic, claims-based measure of EST designed to be applied as a universal quality measure for child psychotherapy encounters in a state Medicaid system. Methods Implementation potential of the EST measure was assessed with healthcare leader rankings of the reporting method’s acceptability, appropriateness and feasibility (n = 53), and post-implementation ratings of EST rate accuracy. Ability of the healthcare system to monitor EST through claims was measured by examining the agency responsivity in using the claims-based measure across 98 Medicaid-contracted community mental health (CMH) agencies in Washington State. Results The analysis found the reporting method had high implementation potential. The method was able to measure the use of an EST for 83% of children covered by Medicaid with 58% CMH agencies reporting > 0 ESTs in one quarter. Qualitative analyses revealed that the most significant barrier to reporting ESTs was the operability of electronic health record systems and agencies’ mixed views regarding the accuracy and benefits of reporting. Conclusions Measurement of child mental health ESTs through Medicaid claims reporting has acceptable implementation potential and promising real world responsiveness from CMH agencies in one state. Variation in reporting by agency site and low to moderate perceived value by agency leaders suggests the need for additional implementation supports for wider uptake.
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Affiliation(s)
- Sarah Cusworth Walker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.
| | - Noah Gubner
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Aniyar Iztguttinov
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Felix Rodriguez
- Washington State Health Care Authority, P.O. Box 45330, Olympia, WA, 98504-5330, USA
| | - Paul Davis
- Washington State Health Care Authority, P.O. Box 45330, Olympia, WA, 98504-5330, USA
| | - Aaron Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 2012 Skagit Lane, Miller Sall, Box 353600, Seattle, WA, 98195, USA
| | - Suzanne Kerns
- School of Social Work, University of Denver, Craig Hall, 2148 South High, St. Denver, CO, 80210, USA
| | - Eric Bruns
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74th Street, Building 29, Suite 110, Seattle, WA, 98115, USA
| | - Jiage Qian
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Georganna Sedlar
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
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13
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Becker KD, Daleiden EL, Kataoka SH, Edwards SM, Best KM, Donohue A, Chorpita BF. Pilot Study of the MAP Curriculum for Psychotherapy Competencies in Child and Adolescent Psychiatry. Am J Psychother 2021; 75:82-88. [PMID: 34724809 DOI: 10.1176/appi.psychotherapy.20210010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This pilot study aimed to evaluate the relevance, feasibility, acceptability, and instructional efficacy of the Managing and Adapting Practice (MAP) curriculum for enhancing the teaching of psychotherapy to child and adolescent psychiatry (CAP) fellows. MAP is a system of resources and decision models that supports practitioners in selecting and implementing psychotherapeutic interventions for children and adolescents. The MAP curriculum includes modules to guide education about psychotherapeutic procedures (e.g., behavioral activation) common in evidence-based treatments for an array of childhood problems and to support development of competencies in assessment, treatment planning, and reflective practice. METHODS Curriculum coding was used to examine the relevance of MAP's core components to the skills articulated in the Accreditation Council for Graduate Medical Education (ACGME) CAP milestones. Feasibility, acceptability, and learning outcomes were examined after delivery of the MAP curriculum to 12 CAP fellows at two sites, with instructional features tailored according to faculty preferences and training program structure. RESULTS Coding suggested that the MAP curriculum was relevant to 95% of the 21 ACGME CAP training subcompetencies. Feasibility was indicated by the successful delivery of 100% of the planned MAP curriculum across the two sites. Acceptability was supported by positive feedback from the CAP fellows, and psychotherapy knowledge increased significantly. Finally, case review scores (mean±SD=2.21±0.15) showed positive posttraining application of MAP to two patients and exceeded scores achieved by other samples of mental health professionals. CONCLUSIONS This pilot study demonstrated the potential for the MAP curriculum to support CAP education. MAP's versatility as a curriculum supports broader adoption, with continuing rigorous empirical evaluation.
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Affiliation(s)
- Kimberly D Becker
- Department of Psychology, University of South Carolina, Columbia (Becker); PracticeWise, Satellite Beach, Florida (Daleiden); Department of Psychiatry and Biobehavioral Sciences, and Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles (Kataoka, Best); Department of Psychiatry, University of Maryland, Baltimore (Edwards, Donohue); Department of Psychology, University of California, Los Angeles (Chorpita)
| | - Eric L Daleiden
- Department of Psychology, University of South Carolina, Columbia (Becker); PracticeWise, Satellite Beach, Florida (Daleiden); Department of Psychiatry and Biobehavioral Sciences, and Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles (Kataoka, Best); Department of Psychiatry, University of Maryland, Baltimore (Edwards, Donohue); Department of Psychology, University of California, Los Angeles (Chorpita)
| | - Sheryl H Kataoka
- Department of Psychology, University of South Carolina, Columbia (Becker); PracticeWise, Satellite Beach, Florida (Daleiden); Department of Psychiatry and Biobehavioral Sciences, and Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles (Kataoka, Best); Department of Psychiatry, University of Maryland, Baltimore (Edwards, Donohue); Department of Psychology, University of California, Los Angeles (Chorpita)
| | - Sarah M Edwards
- Department of Psychology, University of South Carolina, Columbia (Becker); PracticeWise, Satellite Beach, Florida (Daleiden); Department of Psychiatry and Biobehavioral Sciences, and Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles (Kataoka, Best); Department of Psychiatry, University of Maryland, Baltimore (Edwards, Donohue); Department of Psychology, University of California, Los Angeles (Chorpita)
| | - Karin M Best
- Department of Psychology, University of South Carolina, Columbia (Becker); PracticeWise, Satellite Beach, Florida (Daleiden); Department of Psychiatry and Biobehavioral Sciences, and Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles (Kataoka, Best); Department of Psychiatry, University of Maryland, Baltimore (Edwards, Donohue); Department of Psychology, University of California, Los Angeles (Chorpita)
| | - April Donohue
- Department of Psychology, University of South Carolina, Columbia (Becker); PracticeWise, Satellite Beach, Florida (Daleiden); Department of Psychiatry and Biobehavioral Sciences, and Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles (Kataoka, Best); Department of Psychiatry, University of Maryland, Baltimore (Edwards, Donohue); Department of Psychology, University of California, Los Angeles (Chorpita)
| | - Bruce F Chorpita
- Department of Psychology, University of South Carolina, Columbia (Becker); PracticeWise, Satellite Beach, Florida (Daleiden); Department of Psychiatry and Biobehavioral Sciences, and Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles (Kataoka, Best); Department of Psychiatry, University of Maryland, Baltimore (Edwards, Donohue); Department of Psychology, University of California, Los Angeles (Chorpita)
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14
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Boyd MR, Park AL, Becker KD, Chorpita BF. The relation between training asymmetry and supervisory working alliance: implications for the role of supervisors in implementation. CLINICAL SUPERVISOR 2021. [DOI: 10.1080/07325223.2020.1871460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Meredith R. Boyd
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Alayna L. Park
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Kimberly D. Becker
- Department of Psychology, University of South Carolina, Columbia, Carolina, USA
| | - Bruce F. Chorpita
- Department of Psychology, University of California, Los Angeles, California, USA
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15
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Barnett ML, Lau AS, Lind T, Wright B, Stadnick N, Innes-Gomberg D, Pesanti K, Brookman-Frazee L. Caregiver Attendance as a Quality Indicator in the Implementation of Multiple Evidence-Based Practices for Children. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:868-882. [PMID: 31799862 PMCID: PMC7269837 DOI: 10.1080/15374416.2019.1683851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study investigated a quality indicator for children's mental health, caregiver attendance in youth psychotherapy sessions, within a system-driven implementation of multiple evidence-based practices (EBPs) in children's community mental health services. METHOD Administrative claims from nine fiscal years were analyzed to characterize and predict caregiver attendance. Data included characteristics of therapists (n = 8,626), youth clients (n = 134,368), sessions (e.g., individual, family), and the EBP delivered. Clients were primarily Latinx (63%), male (54%) and mean age was 11; they presented with a range of mental health problems. Three-level mixed models were conducted to examine the association between therapist, youth, service, EBP characteristics and caregiver attendance. RESULTS Caregivers attended, on average, 46.0% of sessions per client for the full sample and 59.6% of sessions for clients who were clinically indicated, based on age and presenting problem, to receive caregiver-focused treatment. Following initial EBP implementation, the proportion of caregiver attendance in sessions increased over time. Caregivers attended a higher proportion of youth psychotherapy sessions when clients were younger, had an externalizing disorder, were non-Hispanic White, and were male. Further, higher proportions of caregiver attendance occurred when services were delivered in a clinic setting (compared with school and other settings), by bilingual therapists, and the EBP prescribed caregiver attendance in all sessions. CONCLUSIONS Overall, the patterns of caregiver attendance appear consistent with evidence-informed practice parameters of client presenting problem and age. Yet, several improvement targets emerged such as client racial/ethnic background and service setting. Potential reasons for these disparities are discussed.
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Affiliation(s)
- Miya L. Barnett
- University of California, Santa Barbara, Department of Counseling, Clinical, & School Psychology, Santa Barbara, CA
| | - Anna S. Lau
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA
| | - Teresa Lind
- University of California, San Diego, Department of Psychiatry; Child and Adolescent Services Research Center, San Diego, CA
| | - Blanche Wright
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA
| | - Nicole Stadnick
- University of California, San Diego, Department of Psychiatry; Child and Adolescent Services Research Center, San Diego, CA
| | | | - Keri Pesanti
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Lauren Brookman-Frazee
- University of California, San Diego, Department of Psychiatry; Child and Adolescent Services Research Center, San Diego, CA
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16
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Hoagwood KE, Purtle J, Spandorfer J, Peth-Pierce R, Horwitz SM. Aligning dissemination and implementation science with health policies to improve children's mental health. AMERICAN PSYCHOLOGIST 2020; 75:1130-1145. [PMID: 33252950 PMCID: PMC8034490 DOI: 10.1037/amp0000706] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The prevalence of mental health problems among children (ages 0-21) in the United States remains unacceptably high and, post-COVID-19, is expected to increase dramatically. Decades of psychological knowledge about effective treatments should inform the delivery of better services. Dissemination and implementation (D&I) science has been heralded as a solution to the persistent problem of poor quality services and has, to some extent, improved our understanding of the contexts of delivery systems that implement effective practices. However, there are few studies demonstrating clear, population-level impacts of psychological interventions on children. Momentum is growing among communities, cities, states, and some federal agencies to build "health in all policies" to address broad familial, social, and economic factors known to affect children's healthy development and mental health. These health policy initiatives offer a rare opportunity to repurpose D&I science, shifting it from a primary focus on evidence-based practice implementation, to a focus on policy development and implementation to support child and family health and well-being. This shift is critical as states develop policy responses to address the health and mental health impacts of the COVID-19 pandemic on already-vulnerable families. We provide a typology for building research on D&I and children's mental health policy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University
| | - Julia Spandorfer
- Department of Child and Adolescent Psychiatry, New York University Langone Health
| | | | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University Langone Health
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17
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Frank HE, Becker-Haimes EM, Kendall PC. Therapist training in evidence-based interventions for mental health: A systematic review of training approaches and outcomes. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020; 27:e12330. [PMID: 34092941 PMCID: PMC8174802 DOI: 10.1111/cpsp.12330] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/07/2020] [Indexed: 12/20/2022]
Abstract
A lack of effective therapist training is a major barrier to evidence-based intervention (EBI) delivery in the community. Systematic reviews published nearly a decade ago suggested that traditional EBI training leads to higher knowledge but not more EBI use, indicating that more work is needed to optimize EBI training and implementation. This systematic review synthesizes the training literature published since 2010 to evaluate how different training models (workshop, workshop with consultation, online training, train-the-trainer, and intensive training) affect therapists' knowledge, beliefs, and behaviors. Results and limitations for each approach are discussed. Findings show that training has advanced beyond provision of manuals and brief workshops; more intensive training models show promise for changing therapist behavior. However, methodological issues persist, limiting conclusions and pointing to important areas for future research.
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Affiliation(s)
- Hannah E. Frank
- Psychology Department, Temple University, Philadelphia, Pennsylvania
| | - Emily M. Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Hall Mercer Community Mental Health, Philadelphia, Pennsylvania
| | - Philip C. Kendall
- Psychology Department, Temple University, Philadelphia, Pennsylvania
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18
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Stadnick NA, Lau AS, Dickson KS, Pesanti K, Innes-Gomberg D, Brookman-Frazee L. Service use by youth with autism within a system-driven implementation of evidence-based practices in children's mental health services. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2094-2103. [PMID: 32686469 DOI: 10.1177/1362361320934230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Public mental health systems play an important role in caring for youth with autism spectrum disorder. Like other dually diagnosed populations, youth with autism spectrum disorder may receive services in the context of evidence-based practice implementation efforts within public mental health systems. Little is known about service use patterns within the context of system-driven implementations efforts for this population. This case-control study examined mental health service patterns of 2537 youth with autism spectrum disorder compared to 2537 matched peers receiving care in the Los Angeles County Department of Mental Health, the largest public mental health department in the United States, within the context of a system-driven implementation of multiple evidence-based practices. Although not the primary target of this implementation effort, youth with autism spectrum disorder were served when they met criteria for the services based on their presenting mental health symptoms. Comparative analyses using administrative claims data were conducted to examine differences in mental health utilization patterns and clinical characteristics. Findings revealed significant differences in the volume and duration of mental health services as well as differences in the service type and evidence-based practice delivered between youth with and without autism spectrum disorder. Results provide direction targeting implementation efforts for youth with autism spectrum disorder within a public mental health system care reform.
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Affiliation(s)
- Nicole A Stadnick
- University of California, San Diego, USA.,Dissemination and Implementation Science Center, University of California San Diego, USA.,Child and Adolescent Services Research Center, USA
| | - Anna S Lau
- University of California Los Angeles, USA
| | - Kelsey S Dickson
- Child and Adolescent Services Research Center, USA.,San Diego State University, USA
| | - Keri Pesanti
- Los Angeles County Department of Mental Health, USA
| | | | - Lauren Brookman-Frazee
- University of California, San Diego, USA.,Dissemination and Implementation Science Center, University of California San Diego, USA.,Child and Adolescent Services Research Center, USA.,Autism Discovery Institute, Rady Children's Hospital San Diego, USA
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19
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Becker KD, Dickerson K, Boustani MM, Chorpita BF. Knowing What To Do and When To Do It: Mental Health Professionals and the Evidence Base for Treatment Engagement. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:201-218. [DOI: 10.1007/s10488-020-01067-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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20
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Castillo-Eito L, Armitage CJ, Norman P, Day MR, Dogru OC, Rowe R. How can adolescent aggression be reduced? A multi-level meta-analysis. Clin Psychol Rev 2020; 78:101853. [PMID: 32402919 DOI: 10.1016/j.cpr.2020.101853] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 02/27/2020] [Accepted: 04/09/2020] [Indexed: 12/12/2022]
Abstract
Aggressive behaviour among adolescents has significant social and economic costs. Numerous attempts have been made to intervene to reduce aggression in adolescents. However, little is known about what factors enhance or diminish intervention effectiveness. The present systematic review and meta-analysis, therefore, seeks to quantify the effectiveness of interventions to reduce aggressive behaviour in adolescents and to identify when and for whom such interventions work best. Sixteen databases were searched for randomised controlled trials that assessed interventions to reduce aggression among adolescents. After screening 9795 records, 95 studies were included. A multi-level meta-analysis found a significant overall small-to-medium effect size (d = 0.28; 95% CI [0.17, 0.39]). More effective interventions were of shorter duration, were conducted in the Middle East, were targeted at adolescents with higher levels of risk, and were facilitated by intervention professionals. Potentially active ingredients were classified using the Behaviour Change Technique Taxonomy. Behavioural practice and problem solving were components of more effective interventions targeted at the general population. Overall the findings indicate that psychosocial interventions are effective in reducing adolescent aggression. Future trials need to assess the effect of individual techniques and their combination to identify the key components that can reduce aggression in adolescents.
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Affiliation(s)
- Laura Castillo-Eito
- Department of Psychology, The University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, United Kingdom.
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, M13 9PL, United Kingdom; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9PL, United Kingdom.
| | - Paul Norman
- Department of Psychology, The University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, United Kingdom.
| | - Marianne R Day
- Department of Psychology, The University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, United Kingdom.
| | - Onur C Dogru
- Department of Psychology, The University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, United Kingdom.
| | - Richard Rowe
- Department of Psychology, The University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, United Kingdom.
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21
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Race and Equity in Statewide Implementation Programs: An Application of the Policy Ecology of Implementation Framework. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:946-960. [PMID: 32193757 DOI: 10.1007/s10488-020-01033-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although the literature is growing regarding large-scale, system-wide implementation programs, the broader political and social contexts, including race and ethnicity, are frequently ignored. Using the Policy Ecology of Implementation framework (Raghavan et al., Implement Sci 3:26, 2008), Minnesota's CEMIG is examined to investigate the role of social and political contexts in the implementation process and the barriers they create. Data from 22 interview transcripts from DHS administrators, agency grant managers, university educators, advocacy group representatives, and mental health board members, along with more than 1000 grant documents were qualitatively analyzed using content analysis to reveal three themes concerning how the participants experienced program implementation: invisibility, isolation, and inequity. Findings demonstrate the participants perceived that the grant program perpetuated inequities by neglecting to promote the program, advocate for clinicians of color, and coordinate isolated policy ecology systems. Strategies for future large-scale, system-wide mental health program implementation are provided.
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22
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Sibley MH, Graziano PA, Bickman L, Coxe SJ, Martin P, Rodriguez LM, Fallah N, Ortiz M. Implementing Parent-Teen Motivational Interviewing + Behavior Therapy for ADHD in Community Mental Health. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 22:701-711. [PMID: 32103410 DOI: 10.1007/s11121-020-01105-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite the promise of psychosocial interventions for adolescent Attention Deficit Hyperactivity Disorder (ADHD), there are no studies that examine their implementation in community mental health contexts. In this study, we evaluate the implementation of community-based Supporting Teens' Autonomy Daily (STAND), a parent-teen Motivational Interviewing + Behavior Therapy intervention for adolescents with ADHD. Adolescents with ADHD (N = 225), who were clients at four community mental health agencies, received treatment from 82 therapists. There was double randomization of adolescents and therapists to STAND or Usual Care (UC). Nearly all therapists randomized to STAND completed the training and regularly attended supervision, rating STAND as acceptable and lower burden than UC practices. In the STAND group, MI competence and implementation were lower than in university trials (benchmark range, 19.5% for reflection to question ratio to 83.1% for technical globals). MI integrity in the STAND group was significantly higher than UC across most MITI indices. Content fidelity was adequate in STAND's engagement and skills phases (76.4-85.0%), but not its planning phase (24.4%). Therapists commonly neglected weekly review of goals and home practice and deviated from manualized pace and sequencing of therapy tasks. Learning MI was more challenging for bilingual therapists and therapists with more years of experience. STAND was delivered with higher integrity in earlier sessions and office-based sessions. Discussion identifies future directions for exporting adolescent ADHD interventions to community settings. Patient outcome data for this trial is presented elsewhere. Trial Registration: NCT02694939 www.clinicaltrials.gov .
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Affiliation(s)
- Margaret H Sibley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
- Center for Child Health, Behavior, & Development, Seattle Children's Research Institute, Seattle, WA, USA.
- Center for Children and Families, Florida International University, Miami, FL, USA.
- Department of Psychiatry & Behavioral Health, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
| | - Paulo A Graziano
- Center for Children and Families, Florida International University, Miami, FL, USA
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Leonard Bickman
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Stefany J Coxe
- Center for Children and Families, Florida International University, Miami, FL, USA
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Pablo Martin
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Lourdes M Rodriguez
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Niloofar Fallah
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Mercedes Ortiz
- Center for Children and Families, Florida International University, Miami, FL, USA
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Boustani MM, Frazier SL, Chu W, Lesperance N, Becker KD, Helseth SA, Hedemann ER, Ogle RR, Chorpita BF. Common Elements of Childhood Universal Mental Health Programming. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:475-486. [PMID: 32080783 DOI: 10.1007/s10488-020-01023-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the availability of multiple mental health prevention and promotion programs for children, challenges related to their dissemination limit their reach and impact. This review identifies the most common practice elements of effective childhood universal mental health programming for children ages 3-11, based on a structured interpretation and coding of program manuals and descriptions in peer-reviewed articles. Across a range of program goals and targeted outcomes, psychoeducation and problem solving emerged as the most common practice elements, followed by social skills training, insight building, and communication skills. These skills were largely taught via role-plays and modeling. Synthesizing what we know from the universal mental health programming literature has potential to facilitate dissemination of information to inform the development, adaptation or adoption of programs for children.
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Affiliation(s)
- Maya M Boustani
- Department of Psychology, Loma Linda University, 11130 Anderson St., Suite 117, Loma Linda, CA, 92350, USA.
| | | | - Wendy Chu
- University of California, Los Angeles, Los Angeles, CA, USA
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Westman JG, Daleiden EL, Chorpita BF. The agency supervisor model: developing supervisors who facilitate therapist transfer of training in community behavioral health service organizations. CLINICAL SUPERVISOR 2019. [DOI: 10.1080/07325223.2019.1695159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jonathan G. Westman
- Department of Psychology, University of California, Los Angeles, California, USA
| | | | - Bruce F. Chorpita
- Department of Psychology, University of California, Los Angeles, California, USA
- PracticeWise, LLC., Satellite Beach, Florida, USA
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Community Mental Health Professionals' Perceptions About Engaging Underserved Populations. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 47:366-379. [PMID: 31721005 DOI: 10.1007/s10488-019-00994-3] [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: 10/25/2022]
Abstract
This study explored mental health professionals' perceptions about barriers and facilitators to engaging underserved populations. Responses were coded using an iterative thematic analysis based on grounded theory. Results revealed that many professionals endorsed barriers to engaging ethnic minorities and families receiving social services. Client-provider racial and linguistic matching, therapy processes and procedures (e.g., nonjudgmental stance), and implementation supports (e.g., supervision) were commonly nominated as engagement facilitators. Many professionals felt that an organizational culture focused on productivity is detrimental to client engagement. Findings shed light on professionals' perceived barriers to delivering high-quality care to underserved communities and illuminate potential engagement strategies.
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26
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Rith-Najarian LR, Boustani MM, Chorpita BF. A systematic review of prevention programs targeting depression, anxiety, and stress in university students. J Affect Disord 2019; 257:568-584. [PMID: 31326690 DOI: 10.1016/j.jad.2019.06.035] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 05/05/2019] [Accepted: 06/29/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Given the prevalence of anxiety, depression, and stress among university students, it is important to assess the effectiveness of prevention programs for these problems. Beyond examining effect sizes, applying a common elements approach can enhance our understanding of which practice elements are most frequently included in symptom-reducing programs. METHOD This review examined effective (i.e., outcome-producing) prevention programs targeting depression, anxiety, and/or stress in university students. Programs could be delivered in a group-based, online/computer-delivered, or self-administered format and at the universal, selective, or indicated prevention level. RESULTS The resulting sample of 62 articles covered 68 prevention programs for college, graduate, or professional students across 15 countries. Average effect sizes for programs were moderate (overall g = 0.65), regardless of delivery format or prevention level. The most common practice elements (overall and for programs producing large effects) were: psychoeducation (72%), relaxation (69%), and cognitive monitoring/restructuring (47%). Many programs were limited by: (a) symptom target-outcome mismatches, (b) disproportionately female samples, and (c) inconsistently reported adherence data. LIMITATIONS Commonness of practice elements across outcome-producing interventions does not imply their extensiveness nor unique contribution to effectiveness. Coding was based on information in articles rather than manuals, and inter-rater reliability was moderate for some practice elements. CONCLUSION The outcome-producing prevention programs in our sample had common practice elements and produced moderate reduction in symptoms overall. Future research of depression, anxiety, and stress prevention programs for university students can investigate practice elements' unique and combined impact on outcomes, further explore under-tested practice elements, and use findings to inform intervention design.
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Affiliation(s)
| | - Maya M Boustani
- Department of Psychology, Loma Linda University, United States
| | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, United States
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Managing and Adapting Practice: Provider Perceptions of an Evidence-Informed Framework for Delivering Mental Health Services. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 46:777-789. [PMID: 31302806 DOI: 10.1007/s10488-019-00957-8] [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: 10/26/2022]
Abstract
This study examined providers' reflections on delivering managing and adapting practice (MAP), an evidence-informed framework that guides decision-making from scientific and client data. Consensual qualitative research methods were used to analyze the reflections of 201 youth mental health providers. Results indicated that providers approached MAP according to their own preferences and particular cases. While most appeared to approach MAP from a practice management standpoint, when faced with challenging cases, providers used coordination and outcomes management resources. Regardless of approach, most providers came to appreciate the full framework through reflective practice. Their diverse approaches offer lessons for evidence-based practice implementation and sustainment.
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Skriner LC, Wolk CB, Stewart RE, Adams DR, Rubin RM, Evans AC, Beidas RS. Therapist and Organizational Factors Associated with Participation in Evidence-Based Practice Initiatives in a Large Urban Publicly-Funded Mental Health System. J Behav Health Serv Res 2019; 45:174-186. [PMID: 28439788 DOI: 10.1007/s11414-017-9552-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Laura C Skriner
- Center for Mental Health Policy and Services Research, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA
| | - Courtney Benjamin Wolk
- Center for Mental Health Policy and Services Research, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA
| | - Rebecca E Stewart
- Center for Mental Health Policy and Services Research, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA
| | - Danielle R Adams
- Center for Mental Health Policy and Services Research, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA
| | - Ronnie M Rubin
- Department of Behavioral Health and Intellectual disAbility Services, 1101 Market Street, Floor 7, Philadelphia, PA, 19107, USA
| | - Arthur C Evans
- Center for Mental Health Policy and Services Research, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA
- Department of Behavioral Health and Intellectual disAbility Services, 1101 Market Street, Floor 7, Philadelphia, PA, 19107, USA
| | - Rinad S Beidas
- Center for Mental Health Policy and Services Research, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA.
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Unintended Consequences of Evidence-Based Treatment Policy Reform: Is Implementation the Goal or the Strategy for Higher Quality Care? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:649-660. [PMID: 29445993 DOI: 10.1007/s10488-018-0853-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This study examined patterns of evidence-based treatment (EBT) delivery following a county-wide EBT reform initiative. Data were gathered from 60 youth and their 21 providers, who were instructed to deliver therapy as they normally would under the EBT initiative. Results showed limited applicability of county-supported EBTs to this service sample, and that most youth did not receive traditional delivery of EBTs. Findings suggest that it may be unrealistic to expect providers to deliver EBTs with fidelity with all clients, and that EBT implementation may be best thought of as a strategy for improving mental health services rather than a goal.
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Stadnick NA, Lau AS, Barnett M, Regan J, Aarons GA, Brookman-Frazee L. Comparing Agency Leader and Therapist Perspectives on Evidence-Based Practices: Associations with Individual and Organizational Factors in a Mental Health System-Driven Implementation Effort. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:447-461. [PMID: 29101604 DOI: 10.1007/s10488-017-0835-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Agency leaders and therapists are essential stakeholders in implementation of evidence-based practices (EBPs) within publicly-funded mental health services. Little is known about how these stakeholders differ in their perceptions of specific EBPs and which individual and organizational factors differentially influence these perceptions. Within the context of a system-driven implementation of multiple EBPs, survey data from 160 leaders and 720 therapists were examined to assess differences in perceptions of six EBPs. Findings indicated that leaders and therapists have unique perspectives and preferences regarding EBPs that are shaped by distinct sociodemographic and professional characteristics and aspects of organizational functioning.
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Affiliation(s)
- Nicole A Stadnick
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA.
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Miya Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, USA
| | - Jennifer Regan
- Hathaway-Sycamores Child and Family Services, Pasadena, CA, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA
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Horwitz SM, Lewis K, Gleacher A, Wang N, Bradbury DM, Ray-LaBatt M, Hoagwood KE. Sustainability of an Evidence-Based Practice in Community Mental Health Agencies Serving Children. Psychiatr Serv 2019; 70:413-416. [PMID: 30755132 DOI: 10.1176/appi.ps.201800430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors documented rates of sustained use of an evidence-based practice following training sponsored by New York State (NYS), and they identified clinician characteristics related to sustained use. METHODS Clinicians (N=89) who were employed in licensed NYS Office of Mental Health agencies serving children and adolescents and who were trained to proficiency in Managing and Adapting Practice (MAP) in 2016 were contacted between 9 and 18 months later and asked whether they were still using (users) or had stopped using (nonusers) MAP and their reason for doing so. RESULTS Responses were received from 57% of trainees and of those, 80% reported continued use of MAP. Score on the appeal subscale of the Evidence-Based Practices Attitude Scale (EBPAS) was the only significant difference between users and nonusers. CONCLUSIONS Most clinicians reported sustained use of MAP. The EBPAS appeal subscale can be used to identify clinicians who are likely to discontinue use.
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Affiliation(s)
- Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (Horwitz, Lewis, Gleacher, Wang, Hoagwood); Division of Integrated Community Services for Children and Families, New York State Office of Mental Health (NYS OMH), Albany (Bradbury, Ray-LaBatt)
| | - Kristen Lewis
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (Horwitz, Lewis, Gleacher, Wang, Hoagwood); Division of Integrated Community Services for Children and Families, New York State Office of Mental Health (NYS OMH), Albany (Bradbury, Ray-LaBatt)
| | - Alissa Gleacher
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (Horwitz, Lewis, Gleacher, Wang, Hoagwood); Division of Integrated Community Services for Children and Families, New York State Office of Mental Health (NYS OMH), Albany (Bradbury, Ray-LaBatt)
| | - Nicole Wang
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (Horwitz, Lewis, Gleacher, Wang, Hoagwood); Division of Integrated Community Services for Children and Families, New York State Office of Mental Health (NYS OMH), Albany (Bradbury, Ray-LaBatt)
| | - Donna M Bradbury
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (Horwitz, Lewis, Gleacher, Wang, Hoagwood); Division of Integrated Community Services for Children and Families, New York State Office of Mental Health (NYS OMH), Albany (Bradbury, Ray-LaBatt)
| | - Meredith Ray-LaBatt
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (Horwitz, Lewis, Gleacher, Wang, Hoagwood); Division of Integrated Community Services for Children and Families, New York State Office of Mental Health (NYS OMH), Albany (Bradbury, Ray-LaBatt)
| | - Kimberly Eaton Hoagwood
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (Horwitz, Lewis, Gleacher, Wang, Hoagwood); Division of Integrated Community Services for Children and Families, New York State Office of Mental Health (NYS OMH), Albany (Bradbury, Ray-LaBatt)
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Predicting Youth Improvement in Community-Based Residential Settings with Practices Derived from the Evidence-Base. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 46:458-473. [PMID: 30767101 DOI: 10.1007/s10488-019-00925-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The current investigation conducted descriptive analyses on key variables in community-based residential (CBR) settings and investigated the extent to which disruptive youth between the ages of 13 and 17 years improved based on therapists' reported alignment with using practices derived from the evidence-base (PDEBs). Results from both the descriptive analyses and multilevel modeling suggested that therapists are using practices that both do and do not align with the evidence-base for disruptive youth. In addition, both PDEBs and practices with minimal evidence-support predicted or marginally predicted final average progress rating for these youth. Findings are discussed as they relate to the importance of continued exploration of treatment outcomes for CBR youth.
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Hogue A, Bobek M, Dauber S, Henderson CE, McLeod BD, Southam-Gerow MA. Core Elements of Family Therapy for Adolescent Behavior Problems: Empirical Distillation of Three Manualized Treatments. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 48:29-41. [PMID: 30657722 DOI: 10.1080/15374416.2018.1555762] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Family therapy has the strongest evidence base for treating adolescent conduct and substance use problems, yet there remain substantial barriers to widespread delivery of this approach in community settings. This study aimed to promote the feasibility of implementing family-based interventions in usual care by empirically distilling the core practice elements of three manualized treatments. The study sampled 302 high-fidelity treatment sessions from 196 cases enrolled in 1 of 3 manualized family therapy models: multidimensional family therapy (102 sessions/56 cases), brief strategic family therapy (100 sessions/94 cases), or functional family therapy (100 sessions/46 cases). Adolescents were 57% male; 41% were African American, 31% White non-Hispanic, 9% Hispanic American, 6% another race/ethnicity, and 13% unknown. The observational fidelity measures of all three models were used to code all 302 sessions. Fidelity ratings were analyzed to derive model-shared treatment techniques via exploratory factor analyses on half the sample; the derived factors were then validated via confirmatory factor analyses supplemented by Bayesian structural equation modeling on the remaining half. Factor analyses distilled 4 clinically coherent practice elements with strong internal consistency: Interactional Change (6 treatment techniques; Cronbach's α = .93), Relational Reframe (7 techniques; α = .79), Adolescent Engagement (4 techniques; α = .68), and Relational Emphasis (4 techniques; α = .67). The 4 empirically derived factors represent the core elements of 3 manualized family therapy models for adolescent behavior problems, setting the foundation of a more sustainable option for delivering evidence-based family interventions in routine practice settings. Public Health Significance: Increasing implementation of high-fidelity family-based interventions would improve the quality of treatment services for adolescent conduct and substance use problems.
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Affiliation(s)
| | | | | | | | - Bryce D McLeod
- c Department of Psychology , Virginia Commonwealth University
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O'Connor EE, Langer DA. I heard it through the grapevine: Where and what parents learn about youth mental health treatments. J Clin Psychol 2018; 75:710-725. [PMID: 30368805 DOI: 10.1002/jclp.22706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study investigates where parents learn about, and what parents know about child mental health services. Parents who are better informed about mental health services may be more likely to utilize services for their children. METHODS In a national online survey, 196 parents of children between the ages of 4 and 17 years reported on their information-seeking behaviors and their familiarity and experience with psychosocial approaches. RESULTS Parents reported utilizing multiple information sources with mental health providers, pediatricians, and social networks being the most prominent. Parents' trust in different sources varied, with parents generally trusting healthcare professionals the most. Parents exposed to mental health services were more aware of specific therapeutic approaches. CONCLUSIONS Data on how parents receive and understand mental health-related information contributes to ongoing dissemination and implementation efforts.
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Affiliation(s)
- Erin E O'Connor
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts
| | - David A Langer
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts
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Wolitzky-Taylor K, Fenwick K, Lengnick-Hall R, Grossman J, Bearman SK, Arch J, Miranda J, Chung B. A Preliminary Exploration of the Barriers to Delivering (and Receiving) Exposure-Based Cognitive Behavioral Therapy for Anxiety Disorders in Adult Community Mental Health Settings. Community Ment Health J 2018; 54:899-911. [PMID: 29524078 PMCID: PMC6129437 DOI: 10.1007/s10597-018-0252-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 02/22/2018] [Indexed: 11/29/2022]
Abstract
Despite the effectiveness of exposure-based cognitive behavioral therapy (CBT) for anxiety disorders, few individuals in need receive this treatment, particularly in community mental health settings serving low-income adults. The present study took a preliminary step to understand these barriers by conducting a series of key informant interviews and focus groups among patients, providers, clinical administrators, and policy makers. Several themes emerged as barriers to the delivery of exposure-based CBT in these settings, including therapist training and compentency issues, logistical issues, and funding stream issues. Clinical implications and future research that can build from these data are discussed.
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Affiliation(s)
- Kate Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, USA.
| | - Karissa Fenwick
- Department of Social Work, University of Southern California, Los Angeles, USA
| | | | - Jason Grossman
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, USA
| | - Sarah Kate Bearman
- Department of Educational Psychology, University of Texas at Austin, Austin, USA
| | - Joanna Arch
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, USA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, USA
| | - Bowen Chung
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, USA
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Park AL, Moskowitz AL, Chorpita BF. Community-Based Providers' Selection of Practices for Children and Adolescents With Comorbid Mental Health Problems. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2018; 47:796-807. [PMID: 27610741 PMCID: PMC5344770 DOI: 10.1080/15374416.2016.1188706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The goal of this study is to explore providers' patterns of implementation by investigating how community mental health providers selected therapy practice modules from a flexible, modular evidence-based treatment working with youths with comorbid mental health problems. Data were obtained from 57 youths, 5-15 years old, presenting with anxiety, depressive, and/or conduct problems and their 27 providers during their participation in an effectiveness trial involving a modular evidence-based treatment. Although all youths evidenced clinically elevated symptomatology in at least two problem areas, providers targeted youths' comorbid problems with only about half of their study cases. Practice modules indicated for youths' comorbid problems were typically used less frequently and with less depth relative to practice modules indicated for youths' principal clinical problem and were often transdiagnostic in nature (i.e., designed to target more than one problem area). To determine whether providers' decisions to target youths' comorbid problems were systematic, multilevel, logistic regression analyses were conducted and revealed that youths' pretreatment characteristics and time in therapy influenced providers' patterns of module selection. Providers tend to use, but not exploit, the flexibility allowed by modular EBTs and to focus treatment on youths' principal presenting problem. In addition, providers appear to make these practice choices in a systematic and rational manner, and whether and which choices are associated with improved outcomes is an important area of future study.
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Affiliation(s)
- Alayna L Park
- a Department of Psychology , University of California , Los Angeles
| | | | - Bruce F Chorpita
- a Department of Psychology , University of California , Los Angeles
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Barnett ML, Brookman-Frazee L, Gonzalez JC, Zhan C, Rodriguez A, Stadnick NA, Lau AS. Qualitative Reports of How and When Therapists Adapt Children's Evidence-Based Practices during Community Implementation. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 48:894-905. [PMID: 30024316 DOI: 10.1080/15374416.2018.1485107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study analyzed qualitative therapist reports of adaptations to the delivery of multiple evidence-based practices (EBPs) within the context of a system-driven reform of children's community mental health services to understand how therapists adapt EBPs as well as contexts of these adaptations to identify when these adaptations are made. The study sought to complement and expand upon previous quantitative survey findings of two categories of Augmenting and Reducing/Reordering adaptations to EBPs. Data included interviews from 60 therapists (88.3% female, 61.7% Latina/o, 80.0% unlicensed) across 20 program sites in 11 mental health agencies that served racial/ethnically diverse children. Interviews were coded to identify themes surrounding the types of adaptations made and the contexts for these adaptations. The majority of therapists' qualitative descriptions of adaptations converged with the 2 broad categories in the Augmenting and Reducing/Reordering Framework, with therapists describing augmenting (e.g., modifying presentation, lengthening or extending pacing) most often, and reducing/reordering adaptations were discussed less frequently. Child and family characteristics were most frequently cited as indications prompting adaptations; however, the specific characteristics motivating adaptations differed by type. Therapists reporting using augmenting adaptations in the context of a wide range of client characteristics, whereas reducing/reordering adaptations occurred more specifically as a function of clinical presentation, family and caregiver functioning, and emergent life events. Therapists described making adaptations to improve the fit of multiple EBPs for the clients they served. Findings could have implications for implementation efforts with diverse clients served in community settings.
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Affiliation(s)
- Miya L Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego and Child and Adolescent Service Research Center
| | - Juan Carlos Gonzalez
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara
| | - Chanel Zhan
- Department of Psychology, University of California, Los Angeles
| | | | - Nicole A Stadnick
- Department of Psychiatry, University of California, San Diego and Child and Adolescent Service Research Center
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles
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Lau A, Barnett M, Stadnick N, Saifan D, Regan J, Wiltsey Stirman S, Roesch S, Brookman-Frazee L. Therapist report of adaptations to delivery of evidence-based practices within a system-driven reform of publicly funded children's mental health services. J Consult Clin Psychol 2017; 85:664-675. [PMID: 28471210 PMCID: PMC5501960 DOI: 10.1037/ccp0000215] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined clinical adaptations reported by community therapists to multiple evidence-based practices (EBPs) currently implemented in children's mental health services. Based on an item set informed by Stirman and colleagues' model (2015), 2 factors emerged describing Augmenting adaptations and Reducing/Reordering adaptations. We used multilevel modeling to examine therapist- and practice-level predictors of therapist reports of each type of adaptation. METHOD Data were drawn from an online survey, including a novel therapist report measure of EBP adaptations, completed by 572 therapists (89.2% female, Mage = 37.08 years, 33.4% non-Hispanic White) delivering EBPs in the context of a system-driven, fiscally mandated implementation effort. RESULTS Analyses revealed that the 2 types of therapist adaptations (Augmenting and Reducing/Reordering) could be readily discriminated, with therapists reporting significantly more Augmenting than Reducing/Reordering adaptations. Therapists of Hispanic/Latino ethnicity and with fewer years of experience reported more extensive Augmenting adaptations, but no therapist background characteristics were associated with Reducing/Reordering adaptations. Therapists' general attitudes that EBPs diverged from their personal approach to therapy were associated with reporting more Augmenting and Reducing/Reordering adaptations. In contrast, negative perceptions toward the specific EBP predicted Reducing/Reordering adaptations, but not Augmenting adaptations. CONCLUSIONS Community therapist reports suggest that most adaptations undertaken involve engaging with the practice to augment the fit of the EBPs for local contexts; however, when practices were perceived negatively, therapists were more likely to make adaptations reducing or rearranging components. (PsycINFO Database Record
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Affiliation(s)
- Anna Lau
- Department of Psychology, University of California, Los Angeles
| | - Miya Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara
| | - Nicole Stadnick
- Department of Psychiatry, Child and Adolescent Services Research Center, University of California, San Diego
| | - Dana Saifan
- Department of Psychology, University of California, Los Angeles
| | | | | | - Scott Roesch
- Department of Psychology, San Diego State University
| | - Lauren Brookman-Frazee
- Department of Psychiatry, Child and Adolescent Services Research Center, University of California, San Diego
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Hogue A, Bobek M, Dauber S, Henderson CE, McLeod BD, Southam-Gerow MA. Distilling the Core Elements of Family Therapy for Adolescent Substance Use: Conceptual and Empirical Solutions. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2017; 26:437-453. [PMID: 30705581 DOI: 10.1080/1067828x.2017.1322020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This article describes several barriers to widespread dissemination of manualized family-based treatments for adolescent substance use (ASU). We then offer a highly promising solution for adopting and sustaining family therapy in usual care: distilling the core practice elements of empirically validated family therapy models for ASU. We present a conceptual distillation of family therapy for ASU grounded in existing observational fidelity measures for three manualized models, a process that yielded four core elements: Family Engagement, Relational Reframing, Family Behavior Change, and Family Restructuring. We then introduce an innovative empirical method for distilling core elements that can serve as a template for rigorous distillation of other treatment approaches. Finally, we discuss how core elements can enhance family therapy services within the diverse workforce of usual care for ASU.
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Affiliation(s)
- Aaron Hogue
- National Center on Addiction and Substance Abuse
| | - Molly Bobek
- National Center on Addiction and Substance Abuse
| | - Sarah Dauber
- National Center on Addiction and Substance Abuse
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Kazdin AE, Fitzsimmons-Craft EE, Wilfley DE. Addressing critical gaps in the treatment of eating disorders. Int J Eat Disord 2017; 50:170-189. [PMID: 28102908 PMCID: PMC6169314 DOI: 10.1002/eat.22670] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 12/11/2022]
Abstract
Remarkable progress has been made in developing psychosocial interventions for eating disorders and other mental disorders. Two priorities in providing treatment consist of addressing the research-practice gap and the treatment gap. The research-practice gap pertains to the dissemination of evidence-based treatments from controlled settings to routine clinical care. Closing the gap between what is known about effective treatment and what is actually provided to patients who receive care is crucial in improving mental health care, particularly for conditions such as eating disorders. The treatment gap pertains to extending treatments in ways that will reach the large number of people in need of clinical care who currently receive nothing. Currently, in the United States (and worldwide), the vast majority of individuals in need of mental health services for eating disorders and other mental health problems do not receive treatment. This article discusses the approaches required to better ensure: (1) that more people who are receiving treatment obtain high-quality, evidence-based care, using such strategies as train-the-trainer, web-centered training, best-buy interventions, electronic support tools, higher-level support and policy; and (2) that a higher proportion of those who are currently underserved receive treatment, using such strategies as task shifting and disruptive innovations, including treatment delivery via telemedicine, the Internet, and mobile apps.
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Affiliation(s)
- Alan E. Kazdin
- Department of Psychology, Yale University, New Haven, CT, USA
| | | | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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At the Intersection of Health Information Technology and Decision Support: Measurement Feedback Systems... and Beyond. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 43:471-7. [PMID: 26604202 DOI: 10.1007/s10488-015-0702-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We select and comment on concepts and examples from the target articles in this special issue on measurement feedback systems, placing them in the context of some of our own insights and ideas about measurement feedback systems, and where those systems lie at the intersection of technology and decision making. We contend that, connected to the many implementation challenges relevant to many new technologies, there are fundamental design challenges that await a more elaborate specification of the clinical information and decision models that underlie these systems. Candidate features of such models are discussed, which include referencing multiple evidence bases, facilitating observed and expected value comparisons, fostering collaboration, and allowing translation across multiple ontological systems. We call for a new metaphor for these technologies that goes beyond measurement feedback and encourages a deeper consideration of the increasingly complex clinical decision models needed to manage the uncertainty of delivering clinical care.
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Creed TA, Frankel SA, German RE, Green KL, Jager-Hyman S, Taylor KP, Adler AD, Wolk CB, Stirman SW, Waltman SH, Williston MA, Sherrill R, Evans AC, Beck AT. Implementation of transdiagnostic cognitive therapy in community behavioral health: The Beck Community Initiative. J Consult Clin Psychol 2016; 84:1116-1126. [PMID: 27379492 PMCID: PMC5125881 DOI: 10.1037/ccp0000105] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Progress bringing evidence-based practice (EBP) to community behavioral health (CBH) has been slow. This study investigated feasibility, acceptability, and fidelity outcomes of a program to implement transdiagnostic cognitive therapy (CT) across diverse CBH settings, in response to a policy shift toward EBP. METHOD Clinicians (n = 348) from 30 CBH programs participated in workshops and 6 months of consultation. Clinician retention was examined to assess feasibility, and clinician feedback and attitudes were evaluated to assess implementation acceptability. Experts rated clinicians' work samples at baseline, mid-, and end-of-consultation with the Cognitive Therapy Rating Scale (CTRS) to assess fidelity. RESULTS Feasibility was demonstrated through high program retention (i.e., only 4.9% of clinicians withdrew). Turnover of clinicians who participated was low (13.5%) compared to typical CBH turnover rates, even during the high-demand training period. Clinicians reported high acceptability of EBP and CT, and self-reported comfort using CT improved significantly over time. Most clinicians (79.6%) reached established benchmarks of CT competency by the final assessment point. Mixed-effects hierarchical linear models indicated that CTRS scores increased significantly from baseline to the competency assessment (p < .001), on average by 18.65 points. Outcomes did not vary significantly between settings (i.e., outpatient vs. other). CONCLUSIONS Even clinicians motivated by policy-change rather than self-nomination may feasibly be trained to deliver a case-conceptualization driven EBP with high levels of competency and acceptability. (PsycINFO Database Record
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Affiliation(s)
- Torrey A. Creed
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Sarah A. Frankel
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Ramaris E. German
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Kelly L. Green
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Kristin P. Taylor
- Corporal Michael J. Crescenz Veteran's Administration Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104
| | - Abby D. Adler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Courtney B. Wolk
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania. 3535 Market Street, Floor 3, Philadelphia, PA 19104
| | - Shannon W. Stirman
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, (116B-3), 150 South Huntington Avenue, Boston, 02130
| | - Scott H. Waltman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Michael A. Williston
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Rachel Sherrill
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Arthur C. Evans
- Philadelphia Department of Behavioral Health and Intellectual disAbility Services, 801 Market Street, Philadelphia, PA 19107
| | - Aaron T. Beck
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
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Stirman SW, Gutner CA, Langdon K, Graham JR. Bridging the Gap Between Research and Practice in Mental Health Service Settings: An Overview of Developments in Implementation Theory and Research. Behav Ther 2016; 47:920-936. [PMID: 27993341 DOI: 10.1016/j.beth.2015.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 12/09/2015] [Accepted: 12/12/2015] [Indexed: 10/22/2022]
Abstract
Twenty years after Sobell's (1996) influential call to integrate advances in behavior therapy into clinical settings, significant progress has been made in implementation science. In this narrative review, we provide an overview of implementation research findings and highlight recent findings that can inform efforts to bridge the gap between research and practice in mental health service settings. Key findings are summarized, organized according to levels of influence described in two implementation frameworks: The Exploration, Planning, Implementation, and Sustainment Framework (EPIS; Aarons et al., 2011) and the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009). Important levels of influence to consider when implementing new treatments include the outer context, inner context, characteristics of the individual, and characteristics of the innovation. Research on strategies to prepare clinicians to deliver evidence-based psychosocial treatments (EBPTs) and to address contextual barriers to implementation at each level is described, with discussion of implications for the implementation of EBPTs and next steps for research.
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Affiliation(s)
| | - Cassidy A Gutner
- National Center for PTSD, VA Boston Healthcare System; Boston University
| | - Kirsten Langdon
- Department of Psychiatry, Rhode Island Hospital, Providence, RI
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Nadeem E, Weiss D, Olin SS, Hoagwood KE, Horwitz SM. Using a Theory-Guided Learning Collaborative Model to Improve Implementation of EBPs in a State Children's Mental Health System: A Pilot Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 43:978-990. [PMID: 27167744 PMCID: PMC5465642 DOI: 10.1007/s10488-016-0735-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Learning collaboratives (LCs) are used widely to promote implementation of evidence-based practices. However, there has been limited research on the effectiveness of LCs and models vary widely in their structure, focus and components. The goal of the present study was to develop and field test a theory-based LC model to augment a state-led, evidence-based training program for clinicians providing mental health services to children. Analysis of implementation outcomes contrasted LC sites to matched comparison sites that participated in the clinical training program alone. Results suggested that clinicians from sites participating in the LC were more highly engaged in the state-led clinical training program and were more likely to complete program requirements.
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Affiliation(s)
- Erum Nadeem
- Ferkauf Graduate School of Psychology, Yeshiva University, Rousso Building, 1165 Morris Park Avenue, Bronx, NY, 10461, USA.
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA.
| | - Dara Weiss
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA
| | - S Serene Olin
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Kimberly E Hoagwood
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA
- New York State Office of Mental Health, Albany, NY, USA
| | - Sarah M Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA
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45
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Olin SS, Nadeem E, Gleacher A, Weaver J, Weiss D, Hoagwood KE, Horwitz SM. What Predicts Clinician Dropout from State-Sponsored Managing and Adapting Practice Training. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 43:945-956. [PMID: 26699136 PMCID: PMC5545802 DOI: 10.1007/s10488-015-0709-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Dropouts from system-wide evidence-based practice trainings are high; yet there are few studies on what predicts dropouts. This study examined multilevel predictors of clinician dropout from a statewide training on the Managing and Adapting Practice program. Extra-organizational structural variables, intra-organizational variables and clinician variables were examined. Using multivariable logistic regression analysis, state administrative data and prospectively collected clinician participation data were used to predict dropout. Two characteristics were predictive: younger clinicians and those practicing in upstate-rural areas compared to downstate-urban areas were less likely to drop out from training. Implications for research and policy are described.
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Affiliation(s)
- S Serene Olin
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, One Park Avenue, 7th Floor, New York, NY, 10016, USA.
| | - Erum Nadeem
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Alissa Gleacher
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - James Weaver
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Dara Weiss
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Kimberly E Hoagwood
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, One Park Avenue, 7th Floor, New York, NY, 10016, USA
- New York State Office of Mental Health, Albany, NY, USA
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, One Park Avenue, 7th Floor, New York, NY, 10016, USA
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46
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Reding MEJ, Chorpita BF, Lau AS, Innes-Gomberg D. Providers' attitudes toward evidence-based practices: is it just about providers, or do practices matter, too? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 41:767-76. [PMID: 24166077 DOI: 10.1007/s10488-013-0525-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Evidence-based practice (EBP) attitudes were measured in a sample of Los Angeles County mental health service providers. Three types of data were collected: provider demographic characteristics, attitudes toward EBP in general, and attitudes toward specific EBPs being implemented in the county. Providers could reliably rate characteristics of specific EBPs, and these ratings differed across interventions. Preliminary implementation data indicate that appealing features of an EBP relate to the degree to which providers use it. These findings suggest that assessing EBP-specific attitudes is feasible and may offer implementation-relevant information beyond that gained solely from providers' general attitudes toward EBP.
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47
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Eiraldi R, Khanna MS, Jawad AF, Fishman J, Glick HA, Schwartz BS, Cacia J, Wandersman A, Beidas R. A hybrid effectiveness-implementation cluster randomized trial of group CBT for anxiety in urban schools: rationale, design, and methods. Implement Sci 2016; 11:92. [PMID: 27405587 PMCID: PMC4941021 DOI: 10.1186/s13012-016-0453-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 06/08/2016] [Indexed: 11/23/2022] Open
Abstract
Background Schools present a context with great potential for the implementation of psychosocial evidence-based practices. Cognitive behavioral therapy (CBT) is an evidence-based practice that has been found to be very effective in treating anxiety in various community settings, including schools. Friends for Life (FRIENDS) is an efficacious group CBT protocol for anxiety. Unfortunately, evidence-based practices for anxiety are seldom employed in under-resourced urban schools, because many treatment protocols are not a good fit for the urban school context or the population, existing behavioral health staff do not receive adequate training or support to allow them to implement the treatment with fidelity, or school districts do not have the resources to contract with external consultants. In our prior work, we adapted FRIENDS to create a more culturally sensitive, focused, and feasible CBT protocol for anxiety disorders (CBT for Anxiety Treatment in Schools (CATS)). Methods/design The aim of this 5-year study is to evaluate both the effectiveness of CATS for urban public schools compared to the original FRIENDS as well as compare the implementation strategies (train-the-trainer vs. train-the-trainer + ongoing consultation) by conducting a three-arm, parallel group, type 2 hybrid effectiveness-implementation trial in 18 K-8 urban public schools. We will also assess the cost-effectiveness and the mediators and moderators of fidelity. Ninety therapists, 18 agency supervisors, and 360 children will participate. The interactive systems framework for dissemination and implementation guides the training and support procedures for therapists and supervisors. Discussion This study has the potential to demonstrate that agency therapists and supervisors who have had little to no prior exposure to evidence-based practices (EBPs) can implement an anxiety disorder EBP with fidelity. Comparisons of the implementation strategies would provide large urban mental health systems with data to make decisions about the adoption of EBPs. Trial registration ClinicalTrials.gov, NCT02651402
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Affiliation(s)
- Ricardo Eiraldi
- The Children's Hospital of Philadelphia, 3535 Market Street, Rm. 1474, Philadelphia, PA, 19104, USA. .,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Muniya S Khanna
- The Children's Hospital of Philadelphia, 3535 Market Street, Rm. 1474, Philadelphia, PA, 19104, USA
| | - Abbas F Jawad
- The Children's Hospital of Philadelphia, 3535 Market Street, Rm. 1474, Philadelphia, PA, 19104, USA.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Jessica Fishman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA, 19104, USA.,Department of Biostatistics and Epidemiology, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
| | - Henry A Glick
- Wharton School, University of Pennsylvania, 3620 Locust Walk, Philadelphia, PA, 19104, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk # 210, Philadelphia, PA, 19104, USA
| | - Billie S Schwartz
- The Children's Hospital of Philadelphia, 3535 Market Street, Rm. 1474, Philadelphia, PA, 19104, USA
| | - Jaclyn Cacia
- The Children's Hospital of Philadelphia, 3535 Market Street, Rm. 1474, Philadelphia, PA, 19104, USA
| | - Abraham Wandersman
- Department of Psychology, University of South Carolina-Columbia, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC, 29208, USA
| | - Rinad Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA, 19104, USA
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Elkin TD, Sarver DE, Wong Sarver N, Young J, Buttross S. Future Directions for the Implementation and Dissemination of Statewide Developmental-Behavioral Pediatric Integrated Health Care. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:619-630. [PMID: 27210591 DOI: 10.1080/15374416.2016.1152551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The integration of mental health and pediatric health care services has long been a goal for both research and practice. With the advent of federal policies developed to mandate clinical efficiency across the health care spectrum, this issue is becoming more salient. Applied literature on this topic is only recently emerging, however, and there are limited contextual examples to guide program development, research, and refinement. This article presents background information relevant to the development of such a program (the Center for Advancement of Youth). The cultural and organizational contexts for the project are discussed, with particular emphasis on models for cooperation among several institutions of varying size and scope. The implications for the future of tangible research in this area are also discussed, with attention to extending lessons learned to diverse settings motivated to integrate various aspects of health care service provision.
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Affiliation(s)
- T David Elkin
- a Department of Psychiatry and Human Behavior , University of Mississippi Medical Center
| | - Dustin E Sarver
- b Department of Pediatrics , University of Mississippi Medical Center
| | - Nina Wong Sarver
- b Department of Pediatrics , University of Mississippi Medical Center
| | - John Young
- c Department of Psychology , University of Mississippi
| | - Susan Buttross
- b Department of Pediatrics , University of Mississippi Medical Center
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49
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Bruns EJ, Hyde KL, Sather A, Hook AN, Lyon AR. Applying User Input to the Design and Testing of an Electronic Behavioral Health Information System for Wraparound Care Coordination. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 43:350-68. [PMID: 26060099 PMCID: PMC4675692 DOI: 10.1007/s10488-015-0658-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Health information technology (HIT) and care coordination for individuals with complex needs are high priorities for quality improvement in health care. However, there is little empirical guidance about how best to design electronic health record systems and related technologies to facilitate implementation of care coordination models in behavioral health, or how best to apply user input to the design and testing process. In this paper, we describe an iterative development process that incorporated user/stakeholder perspectives at multiple points and resulted in an electronic behavioral health information system (EBHIS) specific to the wraparound care coordination model for youth with serious emotional and behavioral disorders. First, we review foundational HIT research on how EBHIS can enhance efficiency and outcomes of wraparound that was used to inform development. After describing the rationale for and functions of a prototype EBHIS for wraparound, we describe methods and results for a series of six small studies that informed system development across four phases of effort-predevelopment, development, initial user testing, and commercialization-and discuss how these results informed system design and refinement. Finally, we present next steps, challenges to dissemination, and guidance for others aiming to develop specialized behavioral health HIT. The research team's experiences reinforce the opportunity presented by EBHIS to improve care coordination for populations with complex needs, while also pointing to a litany of barriers and challenges to be overcome to implement such technologies.
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Affiliation(s)
- Eric J Bruns
- University of Washington School of Medicine, Seattle, WA, 98105, USA.
- Department of Psychiatry and Behavioral Sciences, University of Washington, 2815 Eastlake Ave E, Suite 200, Seattle, WA, 98102, USA.
| | | | - April Sather
- University of Washington School of Medicine, Seattle, WA, 98105, USA
| | - Alyssa N Hook
- University of Washington School of Medicine, Seattle, WA, 98105, USA
| | - Aaron R Lyon
- University of Washington School of Medicine, Seattle, WA, 98105, USA
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50
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Ng MY, Weisz JR. Annual Research Review: Building a science of personalized intervention for youth mental health. J Child Psychol Psychiatry 2016; 57:216-36. [PMID: 26467325 PMCID: PMC4760855 DOI: 10.1111/jcpp.12470] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Within the past decade, health care service and research priorities have shifted from evidence-based medicine to personalized medicine. In mental health care, a similar shift to personalized intervention may boost the effectiveness and clinical utility of empirically supported therapies (ESTs). The emerging science of personalized intervention will need to encompass evidence-based methods for determining which problems to target and in which order, selecting treatments and deciding whether and how to combine them, and informing ongoing clinical decision-making through monitoring of treatment response throughout episodes of care. We review efforts to develop these methods, drawing primarily from psychotherapy research with youths. Then we propose strategies for building a science of personalized intervention in youth mental health. FINDINGS The growing evidence base for personalizing interventions includes research on therapies adapted for specific subgroups; treatments targeting youths' environments; modular therapies; sequential, multiple assignment, randomized trials; measurement feedback systems; meta-analyses comparing treatments for specific patient characteristics; data-mining decision trees; and individualized metrics. CONCLUSION The science of personalized intervention presents questions that can be addressed in several ways. First, to evaluate and organize personalized interventions, we propose modifying the system used to evaluate and organize ESTs. Second, to help personalizing research keep pace with practice needs, we propose exploiting existing randomized trial data to inform personalizing approaches, prioritizing the personalizing approaches likely to have the greatest impact, conducting more idiographic research, and studying tailoring strategies in usual care. Third, to encourage clinicians' use of personalized intervention research to inform their practice, we propose expanding outlets for research summaries and case studies, developing heuristic frameworks that incorporate personalizing approaches into practice, and integrating personalizing approaches into service delivery systems. Finally, to build a richer understanding of how and why treatments work for particular individuals, we propose accelerating research to identify mediators within and across RCTs, to isolate mechanisms of change, and to inform the shift from diagnoses to psychopathological processes. This ambitious agenda for personalized intervention science, although challenging, could markedly alter the nature of mental health care and the benefit provided to youths and families.
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Affiliation(s)
- Mei Yi Ng
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
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