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Bose D, Pettit JW, Silk JS, Ladouceur CD, Olino TM, Forbes EE, Siegle GJ, Dahl RE, Kendall PC, Ryan ND, McMakin DL. Therapeutic Alliance, Attendance, and Outcomes in Youths Receiving CBT or Client-Centered Therapy for Anxiety. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023:1-11. [PMID: 37796228 PMCID: PMC10995113 DOI: 10.1080/15374416.2023.2261547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Positive associations between therapeutic alliance and outcome (e.g. youth symptom severity) have been documented in the youth anxiety literature; however, little is known about the conditions under which early alliance contributes to positive outcomes in youth. The present study examined the relations between therapeutic alliance, session attendance, and outcomes in youths (N = 135; 55.6% female) who participated in a randomized clinical trial testing the efficacy of cognitive-behavioral therapy or client-centered therapy for anxiety. METHOD We evaluated a conceptual model wherein: (1) early alliance indirectly contributes to positive outcomes by improving session attendance; (2) alliance-outcome associations differ by intervention type, with stronger associations in cognitive-behavioral therapy compared to client-centered therapy; and (3) alliance-outcome associations vary across outcome measurement timepoints, with the effect of early alliance on outcomes decaying over time. RESULTS Contrary to hypotheses, provider ratings of early alliance predicted greater youth-rated anxiety symptom severity post-treatment (i.e. worse treatment outcomes). Session attendance predicted positive youth-rated outcomes, though there was no indirect effect of early alliance on outcomes through session attendance. CONCLUSIONS Results show that increasing session attendance is important for enhancing outcomes and do not support early alliance as a predictor of outcomes.
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Affiliation(s)
- Deepika Bose
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Jeremy W. Pettit
- Department of Psychology and Center for Children and Families, Florida International University, Miami, FL
| | - Jennifer S. Silk
- Department of Psychology, University of Pittsburgh, and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburg, PA
| | - Cecile D. Ladouceur
- Department of Psychology, University of Pittsburgh, and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburg, PA
| | - Thomas M. Olino
- Department of Psychology, Temple University, Philadelphia, PA
| | - Erika E. Forbes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburg, PA
| | - Greg J. Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburg, PA
| | - Ronald E. Dahl
- School of Public Health, University of California at Berkeley, Berkeley, CA
| | | | - Neal D. Ryan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburg, PA
| | - Dana L. McMakin
- Department of Psychology and Center for Children and Families, Florida International University, Miami, FL
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2
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Farrell LJ, Waters AM, Storch EA, Simcock G, Perkes IE, Grisham JR, Dyason KM, Ollendick TH. Closing the Gap for Children with OCD: A Staged-Care Model of Cognitive Behavioural Therapy with Exposure and Response Prevention. Clin Child Fam Psychol Rev 2023; 26:642-664. [PMID: 37405675 PMCID: PMC10465687 DOI: 10.1007/s10567-023-00439-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/06/2023]
Abstract
Childhood obsessive-compulsive disorder (OCD) is among the most prevalent and disabling mental health conditions affecting children and adolescents. Although the distress and burden associated with childhood OCD are well documented and empirically supported treatments are available, there remains an unacceptable "treatment gap" and "quality gap" in the provision of services for youth suffering from OCD. The treatment gap represents the large number of children who never receive mental health services for OCD, while the quality gap refers to the children and young people who do access services, but do not receive evidence-based, cognitive behavioural therapy with exposure and response prevention (CBT-ERP). We propose a novel staged-care model of CBT-ERP that aims to improve the treatment access to high-quality CBT-ERP, as well as enhance the treatment outcomes for youth. In staged care, patients receive hierarchically arranged service packages that vary according to the intensity, duration, and mix of treatment options, with provision of care from prevention, early intervention, through to first and second-line treatments. Based on a comprehensive review of the literature on treatment outcomes and predictors of treatments response, we propose a preliminary staging algorithm to determine the level of clinical care, informed by three key determinants: severity of illness, comorbidity, and prior treatment history. The proposed clinical staging model for paediatric OCD prioritises high-quality care for children at all stages and levels of illness, utilising empirically supported CBT-ERP, across multiple modalities, combined with evidence-informed, clinical decision-making heuristics. While informed by evidence, the proposed staging model requires empirical validation before it is ready for prime time.
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Affiliation(s)
- Lara J Farrell
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia.
| | - Allison M Waters
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, Mount Gravatt Campus, Mount Gravatt, Australia
| | | | - Gabrielle Simcock
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia
| | - Iain E Perkes
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Westmead, NSW, Australia
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Katelyn M Dyason
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Westmead, NSW, Australia
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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3
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Lange AMC, Humayun S, Jefford T. The Feasibility of Providing Remote Functional Family Therapy with Adolescents During the COVID-19 Pandemic: A Mixed-Method Study. CHILD & YOUTH CARE FORUM 2023; 52:441-466. [PMID: 35531310 PMCID: PMC9060401 DOI: 10.1007/s10566-022-09692-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/03/2022]
Abstract
Background Due to the recent COVID-19 pandemic, mental health care has largely transferred its services to online platforms, using videoconferencing (VC) or teletherapy. Within the field of family therapy, however, there is little evidence on the feasibility of using VC, especially when working with whole families at the edge of care. Objective This study investigated the feasibility of remote Functional Family Therapy (FFT), using a mixed-method approach. Method Study 1 consisted of semi-structured interviews with 23 FFT professionals (18 female) about their experience of providing remote FFT during the COVID-19 pandemic. Study 2 included monitoring data of 209 FFT clients (46% female, M age = 14.00) who participated in FFT during the pandemic. We compared families who received mainly in-person, mainly remote or a mix of remote and in-person on client-reported alliance, drop-out, therapist-rated outcomes, and treatment intensity using MANCOVA's and chi-square tests. Results In Study 1 two themes emerged around experienced challenges, namely 'Feeling in control' and 'Engagement and alliance'. Two other themes emerged around adaptations, namely 'Being more on top' and 'Connecting in different ways'. In Study 2, we found that the therapeutic alliance was not related to using VC. Also, families had less between-session contact during the Engagement and Motivation Phase when receiving mainly VC, but had more sessions and longer therapy when receiving a mix of in-person and remote therapy. Conclusions The current study suggests that providing systemic family teletherapy to families on the edge of care is feasible. Further development of systemic family teletherapy is warranted. Supplementary Information The online version contains supplementary material available at 10.1007/s10566-022-09692-y.
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Affiliation(s)
- Aurelie M. C. Lange
- Family Psychology Mutual CIC, Huntingdon, UK ,grid.36316.310000 0001 0806 5472School of Human Science, University of Greenwich, London, UK
| | - Sajid Humayun
- grid.36316.310000 0001 0806 5472School of Human Science, University of Greenwich, London, UK
| | - Tom Jefford
- Family Psychology Mutual CIC, Huntingdon, UK
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Ramshaw G, McKeown A, Lee R, Conlon A, Brown D, Kennedy PJ. Introduction of Technology to Support Young People’s Care and Mental Health—A Rapid Evidence Review. CHILD & YOUTH CARE FORUM 2022; 52:509-531. [PMID: 35966643 PMCID: PMC9362215 DOI: 10.1007/s10566-022-09700-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/23/2022]
Abstract
Background Technology and its use within mental health services has advanced dramatically over recent years. Opportunities for mental health services to utilise technology to introduce novel, effective, and more efficient means of delivering assessment, and treatment are increasing. Objective The current rapid-evidence paper reviews evidence regarding the introduction of novel technology to support young people’s mental health and psychological well-being. Methods A rapid evidence review was conducted. PSYCHINFO and CINAHL were searched for research articles between 2016 and 2021 that were specific to young people, mental health, and technology developments within this domain. N = 27 studies which explored the introduction, feasibility, and value of technology for mental health purposes were included in a narrative synthesis. Quality or risk of bias analyses were not completed. Results Overall, technological advancements in young people’s care were considered positive and engaging for young people. Factors including resources, efficiency of care, engagement, therapeutic effectiveness, ethical considerations, therapeutic alliance, and flexibility were considered within this review. Nevertheless, potential barriers include clinician concerns, socioeconomic factors, and motivation. Conclusion Effective and sustained use of technology within young people’s mental health services will depend on the technology’s usability, efficiency, and ability to engage young people. This paper expands on existing research by reviewing a broader range of technology proposed to support young people’s mental health and well-being. This will assist in the application of novel technological advancements by indicating effectiveness, preferences, potential barriers, and recommendations for the feasibility and efficacy of introducing technology into young people’s services.
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Martinez RG, van Dyk IS, Kroll JL, Emerson ND, Bursch B. Recommendations for building telemental health relationships with youth: A systematic review and resource for clinicians. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 7:349-362. [PMID: 36248612 PMCID: PMC9562612 DOI: 10.1080/23794925.2021.1970050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Ruben G. Martinez
- Department of Psychiatry & Biobehavioral Sciences, UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA
| | - Ilana Seager van Dyk
- Department of Social & Behavioral Science, Yale School of Public Health, New Haven, CT
| | - Juliet L. Kroll
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TC
| | - Natacha D. Emerson
- Department of Psychiatry & Biobehavioral Sciences, UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA
| | - Brenda Bursch
- Department of Psychiatry & Biobehavioral Sciences, UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA,Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA
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6
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Lange AMC, Delsing MJMH, van Geffen M, Scholte RHJ. Alliance Between Therapist and Multi-stressed Families During the COVID-19 Pandemic: The Effect of Family-Based Videoconferencing. CHILD & YOUTH CARE FORUM 2021; 51:593-611. [PMID: 34421286 PMCID: PMC8370056 DOI: 10.1007/s10566-021-09644-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
Background A strong therapeutic alliance or working relationship is essential for effective face-to-face family-based psychotherapy. However, little is known about the use of VC on alliance in family-based therapy. The recent COVID-19 pandemic led to a national lockdown during which most family-based therapy transferred to VC. Objective The current study analyzed the development and strength of alliance prior and during lockdown for multi-stressed families participating in Multisystemic Therapy (MST). Method Alliance with the therapist was reported monthly by 846 caregivers (81% female). Using latent growth curve models (longitudinal approach), the development of alliance was estimated for families participating in MST prior to the lockdown, transferring to VC early in treatment or late in treatment. Using regression analyses (cross-sectional approach), lockdown (yes/no) was included as predictor of alliance. In these analyses, type of family (regular; intellectual disability; concerns regarding child abuse or neglect) and gender of caregiver were included as moderators. Results Both analytical approaches showed that alliance was not affected by VC, except for families with concerns of child abuse, who reported lower alliances during lockdown. However, these results where no longer significant when controlling for multiple testing. Conclusions Strong alliances can be developed and maintained during family-based VC sessions with multi-stressed families. However, for some subgroups, such as families with concerns of child abuse, VC might not be suitable or sufficient. Future research needs to investigate the potential and limitations of using VC with families.
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Affiliation(s)
- Aurelie. M. C. Lange
- Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
- Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands
| | | | - Marieke van Geffen
- Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands
| | - Ron. H. J. Scholte
- Praktikon, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Tranzo, Tilburg University, Tilburg, The Netherlands
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7
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Palfai TP. Integrating Videoconferencing into Primary Care to Address Alcohol Use Disorder. J Addict Med 2021; 15:8-9. [PMID: 32467416 DOI: 10.1097/adm.0000000000000665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This commentary on Leibowitz et al, "Video Consultation to Increase Treatment of Alcohol Use Disorder in Primary Care: A Pilot Feasibility Study" highlights the potential value of utilizing videoconferencing to address unhealthy drinking in primary care settings, the advantages of centralized expert consultants that may be accessed through technology, and the need for future implementation process and clinical care outcome research.
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Affiliation(s)
- Tibor P Palfai
- Department of Psychological and Brain SciencesBoston University, Boston, MA
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8
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Matheson BE, Bohon C, Lock J. Family-based treatment via videoconference: Clinical recommendations for treatment providers during COVID-19 and beyond. Int J Eat Disord 2020; 53:1142-1154. [PMID: 32533799 PMCID: PMC7323318 DOI: 10.1002/eat.23326] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 12/20/2022]
Abstract
The necessity to employ distance-based methods to deliver on-going eating disorder care due to the novel coronavirus (COVID-19) pandemic represents a dramatic and urgent shift in treatment delivery. Yet, TeleHealth treatments for eating disorders in youth have not been adequately researched or rigorously tested. Based on clinical experience within our clinic and research programs, we aim to highlight the common challenges clinicians may encounter in providing family-based treatment (FBT) via TeleHealth for children and adolescents with anorexia nervosa and bulimia nervosa. We also discuss possible solutions and offer practical considerations for providers delivering FBT in this format. Additional research in TeleHealth treatment for eating disorders in youth may lead to improved access, efficiency, and effectiveness of FBT delivered via videoconferencing.
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Affiliation(s)
- Brittany E. Matheson
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Cara Bohon
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - James Lock
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
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9
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Carpenter AL, Pincus DB, Furr JM, Comer JS. Working From Home: An Initial Pilot Examination of Videoconferencing-Based Cognitive Behavioral Therapy for Anxious Youth Delivered to the Home Setting. Behav Ther 2018; 49:917-930. [PMID: 30316490 PMCID: PMC6190606 DOI: 10.1016/j.beth.2018.01.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/07/2018] [Accepted: 01/20/2018] [Indexed: 12/17/2022]
Abstract
Progress in evidence-based treatments for child anxiety has been hampered by limited accessibility of quality care. This study utilized a multiple baseline design to evaluate the pilot feasibility, acceptability, and preliminary efficacy of real-time, Internet-delivered, family-based cognitive-behavioral therapy for child anxiety delivered to the home setting via videoconferencing. Participants included 13 anxious youth (mean age = 9.85) with a primary/co-primary anxiety disorder diagnosis. Eleven participants (84.6%) completed treatment and all study procedures. Consistent with hypotheses, the intervention was feasible and acceptable to families (i.e., high treatment retention, high client satisfaction, strong therapeutic alliance, and low barriers to participation). Moreover, the novel videoconferencing treatment format showed preliminary efficacy: 76.9% of the intention-to-treat (ITT) sample and 90.9% of treatment completers were treatment responders (i.e., Clinical Global Impressions-Improvement Scale = 1 or 2 at posttreatment), and 69.2% of the ITT sample and 81.8% of treatment completers were diagnostic responders (as per the Anxiety Disorders Interview for Children). Gains were largely maintained at 3-month follow-up evaluation. Outcome patterns within and across subjects are discussed, as well as limitations and the need for further controlled evaluations. With continued support, videoconferencing treatment formats may serve to meaningfully broaden the reach of quality care for youth anxiety disorders.
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Affiliation(s)
| | - Donna B Pincus
- Center for Anxiety and Related Disorders, Boston University
| | - Jami M Furr
- Center for Children and Families, Florida International University
| | - Jonathan S Comer
- Center for Children and Families, Florida International University
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10
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Practical Issues in Delivery of Clinician-to-Patient Telemental Health in an Academic Medical Center. Harv Rev Psychiatry 2018; 25:135-145. [PMID: 28475505 DOI: 10.1097/hrp.0000000000000142] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND In the age of online communication, psychiatric care can now be provided via videoconferencing technologies. While virtual visits as a part of telepsychiatry and telemental health provide a highly efficient and beneficial modality of care, the implementation of virtual visits requires attention to quality and safety issues. As practitioners continue to utilize this technology, issues of clinician licensing, treatment outcomes of virtual visits versus in-person visits, and cost offset require ongoing study. METHODS This review provides an overview of the topics of technology, legal and regulatory issues, clinical issues, and cost savings as they relate to practicing psychiatry and psychology via virtual visits in an academic medical center. We review the telepsychiatry/telemental health effectiveness literature from 2013 to the present. Our literature searches used the following terms: telemental health effective, telepsychiatry effective, telepsychiatry efficacy, and telemental health efficacy. These searches produced 58 articles, reduced to 16 when including only articles that address effectiveness of clinician-to-patient services. RESULTS The technological, legal, and regulatory issues vary from state to state and over time. The emerging research addressing diverse populations and disorders provides strong evidence for the effectiveness of telepsychiatry. Cost savings are difficult to precisely determine and depend on the scope of the cost and benefit measured. CONCLUSION Establishing a telepsychiatry program requires a comprehensive approach with up-to-date legal and technological considerations.
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Myers K, Nelson EL, Rabinowitz T, Hilty D, Baker D, Barnwell SS, Boyce G, Bufka LF, Cain S, Chui L, Comer JS, Cradock C, Goldstein F, Johnston B, Krupinski E, Lo K, Luxton DD, McSwain SD, McWilliams J, North S, Ostrowski J, Pignatiello A, Roth D, Shore J, Turvey C, Varrell JR, Wright S, Bernard J. American Telemedicine Association Practice Guidelines for Telemental Health with Children and Adolescents. Telemed J E Health 2017; 23:779-804. [DOI: 10.1089/tmj.2017.0177] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Kathleen Myers
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Eve-Lynn Nelson
- KU Center for Telemedicine & Telehealth, University of Kansas Medical Center, Kansas City, Kansas
- Department of Pediatrics, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Terry Rabinowitz
- Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, Vermont
- Department of Family Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Donald Hilty
- Psychiatry & Addiction Medicine, Kaweah Delta Medical Center, UC Irvine Affiliate, Visalia, California
- Department of Psychiatry, Keck School of Medicine at University of Southern California, Los Angeles, California
- Research and Health Services, Aligned Telehealth, Calabasas, California
| | - Deborah Baker
- Office of Legal and Regulatory Affairs, Practice Directorate, American Psychological Association, Washington, District of Columbia
| | - Sara Smucker Barnwell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Seattle Psychology PLLC, Seattle, Washington
| | | | - Lynn F. Bufka
- Practice Research and Policy, Practice Directorate, American Psychological Association, Washington, District of Columbia
| | - Sharon Cain
- Child and Adolescent Psychiatry Division, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Lisa Chui
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Jonathan S. Comer
- Center for Children and Families, Florida International University, Miami, Florida
- Mental Health Interventions and Technology (MINT) Program, Florida International University, Miami, Florida
| | | | | | | | - Elizabeth Krupinski
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia
| | - Katherine Lo
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - David D. Luxton
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Office of Forensic Mental Health Services, State of Washington, Olympia, Washington
| | - S. David McSwain
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
- Department of Telehealth Optimization, Medical University of South Carolina, Charleston, South Carolina
| | | | - Steve North
- Center for Rural Health Innovation, Spruce Pine, North Carolina
- Mission Virtual Care, Spruce Pine, North Carolina
| | - Jay Ostrowski
- Behavioral Health Innovation, Charlotte, North Carolina
| | - Antonio Pignatiello
- TeleLink Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Medical Psychiatry Alliance, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - David Roth
- Mind and Body Works, Inc., Honolulu, Hawaii
| | - Jay Shore
- Department of Psychiatry, Center for American Indian and Alaska Native Health, University of Colorado, Denver, Colorado
- Telepsychiatry Committee, American Psychiatric Association, Arlington, Virginia
| | - Carolyn Turvey
- Department of Psychiatry, Carver School of Medicine, University of Iowa, Iowa City, Iowa
| | | | - Shawna Wright
- KU Center for Telemedicine & Telehealth, University of Kansas Medical Center, Kansas City, Kansas
- Wright Psychological Services, Chanute, Kansas
| | - Jordana Bernard
- American Telemedicine Association, Washington, District of Columbia
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Sibley MH, Comer JS, Gonzalez J. Delivering Parent-Teen Therapy for ADHD through Videoconferencing: A Preliminary Investigation. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2017; 39:467-485. [PMID: 28989230 PMCID: PMC5625835 DOI: 10.1007/s10862-017-9598-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Adolescents with ADHD demonstrate notoriously poor treatment utilization. Barriers to access have been partially addressed through tailored therapy content and therapist delivery style; yet, additional challenges to engaging this population remain. To leverage modern technology in support of this aim, the current study investigates parent-teen therapy for ADHD delivered over a videoconferencing format. In this preliminary feasibility study, teens and parents (N=20) received an empirically supported dyadic therapy that incorporates skills-based modules with motivational interviewing. The videoconferencing interface was deemed feasible with nearly all families completing treatment. Acceptable therapeutic alliance was reported and key mechanisms of change were engaged (i.e., adolescent motivation to meet goals, parent strategy implementation). Families reported high satisfaction, despite minor disturbances associated with delivering therapy via videoconferencing. Treatment integrity and fidelity were acceptable, though slightly reduced compared to clinic-based trials of the same protocol. Therapists perceived that videoconferencing enhanced treatment for 50% of families. Reductions in participant ADHD symptoms and organization, time management, and planning problems from baseline to post-treatment were noted by parents and teachers. However, open trial results of this study should be interpreted with caution due to their uncontrolled and preliminary nature.
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Affiliation(s)
- Margaret H. Sibley
- Department of Psychiatry and Behavioral Health, Florida International University, Miami, FL
| | - Jonathan S. Comer
- Department of Psychology, Florida International University, Miami, FL
| | - Jaife Gonzalez
- Center for Children and Families, Florida International University, Miami, FL
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13
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Sibley MH, Comer JS, Gonzalez J. Delivering Parent-Teen Therapy for ADHD through Videoconferencing: A Preliminary Investigation. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2017. [PMID: 28989230 DOI: 10.1007/s10862-017-9658-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Adolescents with ADHD demonstrate notoriously poor treatment utilization. Barriers to access have been partially addressed through tailored therapy content and therapist delivery style; yet, additional challenges to engaging this population remain. To leverage modern technology in support of this aim, the current study investigates parent-teen therapy for ADHD delivered over a videoconferencing format. In this preliminary feasibility study, teens and parents (N=20) received an empirically supported dyadic therapy that incorporates skills-based modules with motivational interviewing. The videoconferencing interface was deemed feasible with nearly all families completing treatment. Acceptable therapeutic alliance was reported and key mechanisms of change were engaged (i.e., adolescent motivation to meet goals, parent strategy implementation). Families reported high satisfaction, despite minor disturbances associated with delivering therapy via videoconferencing. Treatment integrity and fidelity were acceptable, though slightly reduced compared to clinic-based trials of the same protocol. Therapists perceived that videoconferencing enhanced treatment for 50% of families. Reductions in participant ADHD symptoms and organization, time management, and planning problems from baseline to post-treatment were noted by parents and teachers. However, open trial results of this study should be interpreted with caution due to their uncontrolled and preliminary nature.
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Affiliation(s)
- Margaret H Sibley
- Department of Psychiatry and Behavioral Health, Florida International University, Miami, FL
| | - Jonathan S Comer
- Department of Psychology, Florida International University, Miami, FL
| | - Jaife Gonzalez
- Center for Children and Families, Florida International University, Miami, FL
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14
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Fleming GE, Kimonis ER, Datyner A, Comer JS. Adapting Internet-Delivered Parent-Child Interaction Therapy to Treat Co-Occurring Disruptive Behavior and Callous-Unemotional Traits: A Case Study. Clin Case Stud 2017. [DOI: 10.1177/1534650117699471] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Disruptive behavior disorders (DBD) are highly prevalent, emerge in early childhood, exhibit considerable stability across time, and are associated with profound disability. When DBD co-occur with callous-unemotional (CU) traits (i.e., lack of empathy/guilt), the risk of early-onset, stable, and severe disruptive behavior is even higher, relative to DBD alone. Early intervention is critical, and there is robust empirical support for the efficacy of parent management training (PMT) for reducing disruptive behavior in young children. However, broad access to these interventions is hindered by numerous systemic barriers, including geographic disparities in availability of services. To overcome these barriers and enhance access and quality of care to underserved communities, several PMT programs have been adapted to online delivery formats, including Parent-Child Interaction Therapy (PCIT). PCIT is an evidence-supported treatment that attempts to reduce disruptive child behavior by improving the parent–child relationship and implementing consistent and effective discipline strategies. Comer and colleagues proposed an online adaptation of PCIT (I-PCIT) that is delivered using video teleconferencing (VTC). I-PCIT was implemented with the family of a 5-year-old Australian boy presenting with clinically significant disruptive behavior and CU traits living in a rural community. Findings from this case report (a) document an improvement in disruptive behavior that was maintained to follow-up and (b) provide preliminary support for adapting PCIT to online delivery formats to enhance accessibility of services and improve child and parent outcomes.
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Affiliation(s)
| | | | - Amy Datyner
- University of New South Wales, Sydney, Australia
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15
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Nelson EL, Cain S, Sharp S. Considerations for Conducting Telemental Health with Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2017; 26:77-91. [PMID: 27837944 DOI: 10.1016/j.chc.2016.07.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Innovative technologies are increasingly used in order to address gaps in access to child behavioral health care. Telemental health is one technological modality in which child behavioral services can be practiced successfully across psychiatry, psychology, and developmental medicine. The authors discuss relevant issues related to delivering telemental health, including why this modality is necessary for delivery, what models and evidence for telemental health exist, when it should be considered across legal/regulatory and ethical considerations, where telemental health services are delivered, who is involved in delivery, and how best telemental health practices may be implemented with diverse youth.
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Affiliation(s)
- Eve-Lynn Nelson
- Pediatrics Department, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; KU Center for Telemedicine and Telehealth, University of Kansas Medical Center, 4330 Shawnee Mission Parkway, Suite 136, MS 7001, Fairway, KS 66205, USA.
| | - Sharon Cain
- Psychiatry & Behavioral Sciences Department, University of Kansas Medical Center, MS 4015, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Susan Sharp
- Psychiatry & Behavioral Sciences Department, University of Kansas Medical Center, MS 4015, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
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Comer JS, Furr JM, Kerns CE, Miguel E, Coxe S, Elkins RM, Carpenter AL, Cornacchio D, Cooper-Vince CE, DeSerisy M, Chou T, Sanchez AL, Khanna M, Franklin ME, Garcia AM, Freeman JB. Internet-delivered, family-based treatment for early-onset OCD: A pilot randomized trial. J Consult Clin Psychol 2016; 85:178-186. [PMID: 27869451 DOI: 10.1037/ccp0000155] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Despite advances in supported treatments for early onset obsessive-compulsive disorder (OCD), progress has been constrained by regionally limited expertise in pediatric OCD. Videoteleconferencing (VTC) methods have proved useful for extending the reach of services for older individuals, but no randomized clinical trials (RCTs) have evaluated VTC for treating early onset OCD. METHOD RCT comparing VTC-delivered family based cognitive-behavioral therapy (FB-CBT) versus clinic-based FB-CBT in the treatment of children ages 4-8 with OCD (N = 22). Pretreatment, posttreatment, and 6-month follow-up assessments included mother-/therapist-reports and independent evaluations masked to treatment condition. Primary analyses focused on treatment retention, engagement and satisfaction. Hierarchical linear modeling preliminarily evaluated the effects of time, treatment condition, and their interactions. "Excellent response" was defined as a 1 or 2 on the Clinical Global Impressions-Improvement Scale. RESULTS Treatment retention, engagement, alliance and satisfaction were high across conditions. Symptom trajectories and family accommodation across both conditions showed outcomes improving from baseline to posttreatment, and continuing through follow-up. At posttreatment, 72.7% of Internet cases and 60% of Clinic cases showed "excellent response," and at follow-up 80% of Internet cases and 66.7% of Clinic cases showed "excellent response." Significant condition differences were not found across outcomes. CONCLUSIONS VTC methods may offer solutions to overcoming traditional barriers to care for early onset OCD by extending the reach of real-time expert services regardless of children's geographic proximity to quality care. (PsycINFO Database Record
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Affiliation(s)
| | - Jami M Furr
- Department of Psychology, Florida International University
| | - Caroline E Kerns
- Department of Psychological and Brain Sciences, Boston University
| | | | - Stefany Coxe
- Department of Psychology, Florida International University
| | | | | | | | | | | | - Tommy Chou
- Department of Psychology, Florida International University
| | | | | | | | - Abbe M Garcia
- Department of Psychiatry and Human Behavior, Brown University
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17
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Cooper-Vince CE, Chou T, Furr JM, Puliafico AC, Comer JS. Videoteleconferencing Early Child Anxiety Treatment: A Case Study of the Internet-Delivered PCIT CALM (I-CALM) Program. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2016; 1:24-39. [PMID: 29104931 PMCID: PMC5669061 DOI: 10.1080/23794925.2016.1191976] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Anxiety disorders are one of the most prevalent and impairing classes of mental health difficulties affecting young children. Though the vast majority of supported programs for child anxiety focus on youth ages 7 years and up, preliminary support has emerged for exposure-based adaptations of parent-coaching interventions, i.e., the Parent Child Interaction Therapy (PCIT) CALM Program, to address anxiety disorders in early childhood. Despite these advances, low rates of community service use and accessibility persist. The increased ubiquity of Internet access has positioned videoteleconferencing (VTC) as a powerful tool to overcome traditional barriers to care. The present case study details the VTC delivery of the PCIT CALM Program in the treatment of a 6 year-old boy presenting with generalized anxiety disorder and separation anxiety disorder. This case provides qualitative support for the feasibility of delivering integrated real-time parent coaching and exposure therapy to address early childhood anxiety disorders via VTC. The remission of the patient's anxiety across treatment sessions suggests that the telehealth format may be a useful modality for the delivery of early childhood anxiety treatment. The technical considerations for the delivery of VTC therapy as well as the implications for treatment are discussed.
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Affiliation(s)
| | - Tommy Chou
- Florida International University, Miami, FL, USA
| | - Jami M Furr
- Center for Children and Families, Florida International University, Miami, FL, USA
| | | | - Jonathan S Comer
- Mental Health Interventions and Technology (MINT) Program, Florida International University, Miami, FL, USA
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Comer JS, Myers K. Future Directions in the Use of Telemental Health to Improve the Accessibility and Quality of Children's Mental Health Services. J Child Adolesc Psychopharmacol 2016; 26:296-300. [PMID: 26859722 PMCID: PMC4841075 DOI: 10.1089/cap.2015.0079] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This concluding commentary offers a brief overview of progress to date in providing telemental health services to children, and then offers a critical vision for future research needed to provide the rigorous empirical foundation for telemental health to be considered a well-established format for the delivery of children's mental health services. METHODS We review how recent years have witnessed advances in the science and practice of children's telemental health, and the articles in this special series collectively offered a critical step forward in the establishment of a guiding literature to provide informed direction for child providers incorporating remote technologies to extend their practices. RESULTS Researchers must be cautious not to develop a "horse race" mentality and a misguided search for a decisive "winner" regarding the ultimate effectiveness of child telemental health versus traditional clinic-based treatments. Instead, research efforts are needed to examine key mediators and moderators of telemental health treatment response. The question should not be simply whether telemental health strategies are supported, but rather when, under what circumstances, and for whom telemental health formats may be most indicated. Barriers to the continued evolution of children's telemental health are discussed, and we consider issues of telemental health reimbursement and matters of cross-state professional jurisdiction. CONCLUSIONS Continued efforts are needed in order to fully actualize the potential of children's telemental health to optimize the quality and transform the accessibility of mental health services for all children, regardless of income or geography.
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Affiliation(s)
- Jonathan S. Comer
- Mental Health Interventions and Technology (MINT) Program, Department of Psychology, Florida International University, Miami, Florida
| | - Kathleen Myers
- Seattle Children's Hospital and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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Chou T, Comer JS, Turvey CL, Karr A, Spargo G. Technological Considerations for the Delivery of Real-Time Child Telemental Healthcare. J Child Adolesc Psychopharmacol 2016; 26:192-7. [PMID: 26491819 PMCID: PMC4841076 DOI: 10.1089/cap.2015.0043] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE In recent years, rapid advances in the sophistication and accessibility of new technologies for consumer use have been leveraged to meaningfully expand the scope of mental health services for youth. However, despite many potential benefits inherent in applying new technologies to improve the accessibility and quality of care, organizations and private providers looking to expand their services with telemental health (TMH) service options may find the broad range of software packages and hardware options daunting. METHODS We summarize key considerations for adopting a videoteleconferencing (VTC) system, and provide recommendations for institutions and providers planning to launch TMH services at varying levels. RESULTS Although there is currently no single combination of VTC software and equipment that works best for every provider, certain factors such as cost, ease of use, and system functionality contribute to the setup that may serve as the "best fit" for practitioners' and clients' needs. CONCLUSIONS Careful consideration of these system characteristics and their bearing on institutional functioning, quality of services, and client satisfaction and privacy prior to VTC installation can proactively reduce difficulties after TMH implementation.
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Affiliation(s)
- Tommy Chou
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida
| | - Jonathan S. Comer
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida
| | - Carolyn L. Turvey
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Ashley Karr
- Iowa City VA Medical Center, Iowa City, Iowa
| | - Garret Spargo
- National Telehealth Technology Assessment Resource Center, Anchorage, Alaska
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