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Beck KB, Nuske HJ, Becker Haimes EM, Lawson GM, Mandell DS. Helping Practitioners Stop, Drop, and Roll: Suggestions to Help Improve Responses to Intense Clinical Events. Psychiatr Serv 2024; 75:817-819. [PMID: 38410040 DOI: 10.1176/appi.ps.20230574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Community practitioners inconsistently implement evidence-based interventions. Implementation science emphasizes the importance of some practitioner characteristics, such as motivation, but factors such as practitioners' emotion regulation and cognitive processing receive less attention. Practitioners often operate in stressful environments that differ from those in which they received training. They may underestimate the impact of their emotional state on their ability to deliver evidence-based interventions. This "hot-cold state empathy gap" is not well studied in mental health care. In this Open Forum, the authors describe scenarios where this gap is affecting practitioners' ability to implement evidence-based practices. The authors provide suggestions to help practitioners plan for stressful situations.
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Affiliation(s)
- Kelly B Beck
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh (Beck); Penn Center for Mental Health (Nuske, Becker Haimes, Mandell) and Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia (Lawson), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Heather J Nuske
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh (Beck); Penn Center for Mental Health (Nuske, Becker Haimes, Mandell) and Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia (Lawson), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Emily M Becker Haimes
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh (Beck); Penn Center for Mental Health (Nuske, Becker Haimes, Mandell) and Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia (Lawson), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Gwendolyn M Lawson
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh (Beck); Penn Center for Mental Health (Nuske, Becker Haimes, Mandell) and Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia (Lawson), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - David S Mandell
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh (Beck); Penn Center for Mental Health (Nuske, Becker Haimes, Mandell) and Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia (Lawson), University of Pennsylvania Perelman School of Medicine, Philadelphia
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Klein CC, Salem H, Becker-Haimes EM, Barnett ML. Therapist Anxious Distress and Avoidance of Implementing Time-Out. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01706-1. [PMID: 38819665 DOI: 10.1007/s10578-024-01706-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 06/01/2024]
Abstract
Therapist anxious distress when delivering child mental health treatment has been understudied as a factor that contributes to the underuse of some evidence-based interventions (EBIs), such as time-out for children with disruptive behaviors. This study investigated therapist anxious avoidance of time-out using a three-part, vignette-based survey design. Therapists (n = 198) read a vignette of an in-session time-out and reported on their personal anxious distress and likelihood of discontinuing the implementation of time-out. Therapists also provided open-ended descriptions of challenges to delivering time-out. Therapists reported moderate anxious distress at time points 1 and 2 and lower anxious distress at time 3 when the time-out had resolved. Most therapists endorsed some avoidance of time-out. Binomial logistic regression analyses indicated that increased anxious distress corresponded with an increased probability of avoiding time-out delivery in the future. Qualitative reports expanded on challenges to implementing time-out. Findings suggest the importance of addressing therapist anxious distress when implementing children's mental health treatments.
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Affiliation(s)
- Corinna C Klein
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA.
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Hanan Salem
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Miya L Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA
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Pellecchia M, Mandell DS, Tomczuk L, Marcus SC, Stewart R, Stahmer AC, Beidas RS, Rieth SR, Lawson GM. A mixed-methods evaluation of organization and individual factors influencing provider intentions to use caregiver coaching in community-based early intervention. Implement Sci Commun 2024; 5:17. [PMID: 38414019 PMCID: PMC10900730 DOI: 10.1186/s43058-024-00552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/25/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Most psycho-social interventions contain multiple components. Practitioners often vary in their implementation of different intervention components. Caregiver coaching is a multicomponent intervention for young autistic children that is highly effective but poorly implemented in community-based early intervention (EI). Previous research has shown that EI providers' intentions, and the determinants of their intentions, to implement caregiver coaching vary across components. Organizational culture and climate likely influence these psychological determinants of intention by affecting beliefs that underlie attitudes, norms, and self-efficacy to implement an intervention. Research in this area is limited, which limits the development of theoretically driven, multilevel implementation strategies to support multi-component interventions. This mixed methods study evaluated the relationships among organizational leadership, culture and climate, attitudes, norms, self-efficacy, and EI providers' intentions to implement the components of caregiver coaching. METHODS We surveyed 264 EI providers from 37 agencies regarding their intentions and determinants of intentions to use caregiver coaching. We also asked questions about the organizational culture, climate, and leadership in their agencies related to caregiver coaching. We used multilevel structural equation models to estimate associations among intentions, psychological determinants of intentions (attitudes, descriptive norms, injunctive norms, and self-efficacy), and organizational factors (implementation climate and leadership). We conducted qualitative interviews with 36 providers, stratified by strength of intentions to use coaching. We used mixed-methods analysis to gain an in-depth understanding of the organization and individual-level factors. RESULTS The associations among intentions, psychological determinants of intentions, and organizational factors varied across core components of caregiver coaching. Qualitative interviews elucidated how providers describe the importance of each component. For example, providers' attitudes toward coaching caregivers and their perceptions of caregivers' expectations for service were particularly salient themes related to their use of caregiver coaching. CONCLUSION Results highlight the importance of multi-level strategies that strategically target individual intervention components as well as organization-level and individual-level constructs. This approach holds promise for improving the implementation of complex, multicomponent, psychosocial interventions in community-based service systems.
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Affiliation(s)
- Melanie Pellecchia
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA.
| | - David S Mandell
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Liza Tomczuk
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Steven C Marcus
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, USA
| | - Rebecca Stewart
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Aubyn C Stahmer
- University of California, Davis, Mind Institute, Sacramento, USA
| | - Rinad S Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Sarah R Rieth
- College of Education, San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, USA
| | - Gwendolyn M Lawson
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
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Johnson C, AlRasheed R, Gray C, Triplett N, Mbwayo A, Weinhold A, Whetten K, Dorsey S. Uncovering determinants of perceived feasibility of TF-CBT through coincidence analysis. IMPLEMENTATION RESEARCH AND PRACTICE 2024; 5:26334895231220277. [PMID: 38322800 PMCID: PMC10775737 DOI: 10.1177/26334895231220277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Introduction A mental health provider's perception of how well an intervention can be carried out in their context (i.e., feasibility) is an important implementation outcome. This article aims to identify determinants of feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) through a case-based causal approach. Method Data come from an implementation-effectiveness study in which lay counselors (teachers and community health volunteers) implemented a culturally adapted manualized mental health intervention, TF-CBT, delivered to teens who were previously orphaned and were experiencing posttraumatic stress symptoms and prolonged grief in Western Kenya. The intervention team identified combinations of determinants that led to feasibility among teacher- and community health volunteer-counselors through coincidence analysis. Results Among teacher-counselors, organizational-level factors (implementation climate, implementation leadership) determined moderate and high levels of feasibility. Among community health volunteer-counselors, a strong relationship between a clinical supervisor and the supervisee was the most influential determinant of feasibility. Conclusion Methodology and findings from this article can guide the assessment of determinants of feasibility and the development of implementation strategies for manualized mental health interventions in contexts like Western Kenya. Plain Language Summary A mental health provider's perception of how easy a therapy is to use in their work setting (i.e., feasibility) can impact whether the provider uses the therapy in their setting. Implementation researchers have recommended finding practices and constructs that lead to important indicators that a therapy will be used. However, limited research to our knowledge has searched and found practices and constructs that might determine feasibility of a therapy. This article uses existing data from a large trial looking at the continued use of a trauma-focused therapy to find practices and constructs that lead to moderate and high levels of feasibility. We found that in settings with a strong organizational structure that organization and leadership support for the therapy led to teachers in Kenya to perceive the therapy as easy to use. On the other hand, in settings with a weaker organizational structure, outside support from a clinical supervisor led to community health volunteers in Kenya perceiving the therapy as easy to use. The findings from this article can guide context-specific recommendations for increasing perceived therapy feasibility at the provider-, organization-, and policy levels.
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Affiliation(s)
- Clara Johnson
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Rashed AlRasheed
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Christine Gray
- Center for Health Policy and Inequities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Noah Triplett
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Andrew Weinhold
- Center for Health Policy and Inequities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Kathryn Whetten
- Center for Health Policy and Inequities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
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Ahuna JK, Becker KD, Chorpita BF. Predicting Therapists' Intentions to Use Innovations: Comparing the Role of Individual, Organizational, and Innovation Characteristics. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:946-965. [PMID: 37715814 DOI: 10.1007/s10488-023-01295-6] [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: 08/16/2023] [Indexed: 09/18/2023]
Abstract
Theories emphasize the role of individual and organizational characteristics in implementation outcomes, yet research indicates that these characteristics account for only a small amount of variance in those outcomes. Innovation characteristics might be important proximal determinants of implementation outcomes but are infrequently examined in mental health services research. This study examined the relative variance explained by individual, organizational, and innovation characteristics on behavioral intentions, a central implementation outcome in implementation theories. Data were collected from 95 therapists and 28 supervisors who participated in a cluster randomized trial that tested the effectiveness of two clinical decision-making innovations. Multilevel models compared individual, organizational, and innovation characteristics as predictors of therapists' intentions to use the innovations. Subsequent mediational path analyses tested whether innovation characteristics mediated the effect of innovation type on intentions. Individual and organizational characteristics explained 29% of the variability in therapists' intentions. Approximately 75% of the variability in therapists' intentions was accounted for by innovation characteristics. Individual and organizational characteristics were not statistically significant predictors of intentions after controlling for innovation characteristics. The indirect effect of innovation type on intentions through therapists' beliefs was statistically significant (B = 0.410, 95% Bootstrapped CI = [0.071, 0.780]), but the direct effect of innovation type was not (B = 0.174, p = .365). Innovation characteristics are related to therapist intentions and might explain why some innovations are received more favorably than others. Future studies should explore the complex interrelationships between these beliefs alongside other individual or organizational characteristics.
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Affiliation(s)
- Jonathan K Ahuna
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC, 29208, USA
| | - Kimberly D Becker
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC, 29208, USA
| | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, Box 951563, Los Angeles, CA, 90095, USA.
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Tan ES, McLeod BD, Mildon RA, Shlonsky A, Seah CKF, McCrickerd K, Goh E, Kembhavi G. Assessing the effectiveness and implementation of a universal classroom-based set of educator practices to improve preschool children's social-emotional outcomes: Protocol for a cluster randomized controlled type 2 hybrid trial in Singapore. PLoS One 2023; 18:e0291723. [PMID: 37729260 PMCID: PMC10511079 DOI: 10.1371/journal.pone.0291723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Providing high-quality early childhood care and education is understood as key to maximizing children's potential to succeed later in life, as it stimulates young children's development of skills and competencies needed to promote optimal outcomes and success later in life. Despite the government's efforts to support the early childhood sector, educators in Singapore continue to report difficulties in implementing practices in classrooms that promote children's social, emotional, and cognitive development. To enhance educators' skills in these domains, we developed the Enhancing And Supporting Early development to better children's Lives (EASEL) Approach, a set of universal, educator-delivered practices for use with 3-6-year-old children in early childhood settings to improve social, emotional, behavioral, and executive functioning (SEB+EF) outcomes. METHODS This study will evaluate the effectiveness and implementation of the EASEL Approach in improving early childhood educators' teaching practices and, in turn, children's SEB+EF outcomes. We will conduct a cluster randomized controlled trial with a type 2 hybrid effectiveness-implementation study in 16 childcare centers. The EPIS (Explore, Prepare, Implement, Sustain) Framework will be used to inform the implementation of the EASEL Approach. Implementation strategies include training, educator self-assessments, practice-based coaching, and data monitoring. Our primary outcome is educators' teaching practices. Secondary outcomes include educators' adoption of the EASEL Approach in everyday practice, the acceptability and feasibility of the EASEL Approach, and children's SEB+EF outcomes. Quantitative and qualitative data will be collected at baseline, six months, and after implementation. CONCLUSION Findings from this study will provide significant evidence on the effectiveness of the EASEL Approach in improving educators' teaching practices and its impact on children's SEB+EF outcomes and the implementation of the EASEL Approach in early childhood classrooms in Singapore. TRIAL REGISTRATION This study was prospectively registered on ClinicalTrials.gov, Identifier: NCT05445947 on 6th July 2022.
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Affiliation(s)
- Evelyn S. Tan
- Centre for Holistic Initiatives for Learning and Development, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Evidence and Implementation, Melbourne, Victoria, Australia
| | - Bryce D. McLeod
- Centre for Holistic Initiatives for Learning and Development, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Robyn A. Mildon
- Centre for Holistic Initiatives for Learning and Development, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Evidence and Implementation, Melbourne, Victoria, Australia
| | - Aron Shlonsky
- Department of Social Work, Monash University, Clayton, Victoria, Australia
| | - Cheryl K. F. Seah
- Centre for Holistic Initiatives for Learning and Development, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Evidence and Implementation, Melbourne, Victoria, Australia
| | - Keri McCrickerd
- Centre for Holistic Initiatives for Learning and Development, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Esther Goh
- Centre for Holistic Initiatives for Learning and Development, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Evidence and Implementation, Melbourne, Victoria, Australia
| | - Gayatri Kembhavi
- Centre for Holistic Initiatives for Learning and Development, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Evidence and Implementation, Melbourne, Victoria, Australia
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Lawson GM, Owens JS, Mandell DS, Tavlin S, Rufe S, Lyon AR, Eiraldi R, Power TJ. Implementation resources to support teachers' use of behavioral classroom interventions: protocol of a randomized pilot trial. Pilot Feasibility Stud 2023; 9:151. [PMID: 37626422 PMCID: PMC10463490 DOI: 10.1186/s40814-023-01381-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Teacher-delivered behavioral classroom management interventions are effective for students with or at-risk for attention-deficit/hyperactivity disorder (ADHD) or other disruptive behavior challenges, but they can be difficult for teachers to use in the classroom. In this study, we will pilot test a package of implementation strategies to support teachers in using behavioral classroom interventions for students with ADHD symptoms. METHODS We will use a 2-group, randomized controlled trial to compare outcomes for teachers who receive Positive Behavior Management Implementation Resources (PBMIR), a theory and data-driven implementation resource package designed to increase teacher implementation of behavioral classroom management interventions, with those who do not receive this additional implementation support. We will measure teacher implementation outcomes (e.g., observed fidelity to behavioral classroom interventions) and student clinical outcomes (e.g., ADHD-related impairment, ADHD symptoms, student-teacher relationship, academic performance) before and after an 8-week intervention period for both groups; we will also measure teacher-reported acceptability, appropriateness, and feasibility for the PBMIR group following the intervention period. DISCUSSION If there is preliminary evidence of feasibility and effectiveness, this pilot study will provide the foundation for evaluation the PBMIR at a larger scale and the potential to improve outcomes for students with or at risk for ADHD. TRIAL REGISTRATION This clinical trial was registered at ClinicalTrials.gov. ( https://clinicaltrials.gov/ ) on 8/5/2022 which was prior to the time of first participant enrollment. The registration number is: NCT05489081.
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Affiliation(s)
- Gwendolyn M Lawson
- Children's Hospital of Philadelphia, Philadelphia, USA.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | | | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Steven Rufe
- Rufe Educational Consulting, LLC, Schwenksville, PA, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Ricardo Eiraldi
- Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Thomas J Power
- Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Lawson GM, Mandell DS, Tomczuk L, Fishman J, Marcus SC, Pellecchia M. Clinician Intentions to use the Components of Parent Coaching Within Community Early Intervention Systems. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:357-365. [PMID: 36525093 PMCID: PMC10191901 DOI: 10.1007/s10488-022-01243-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] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Parent coaching is a complex, psychosocial intervention with multiple core components. Clinicians' use of these core components may be influenced by distinct factors; no research has examined whether clinician perceptions of parent coaching vary across core coaching components. This study aimed to examine the extent to which clinicians working with families of young autistic children in publicly funded early intervention intend to use core parent coaching components, and to examine how closely psychological factors relate to providers' intentions to use each component. METHODS Using the Theory of Planned Behavior as a framework, this study compared the strength of clinicians' intentions across five core parent coaching components: collaboration with parents, delivering the intervention within daily routines, demonstrating the intervention, providing in-vivo feedback, and reflection and problem solving. We examined the associations between intentions and psychological determinants of intentions (i.e., attitudes, norms, and self-efficacy) for each component. RESULTS Clinicians' average intentions varied by core component, with strongest intentions for demonstrating the intervention strategy for a parent. The associations between intentions and psychological determinants also varied by core component. Attitudes, injunctive norms, and self-efficacy, but not descriptive norms, significantly related to clinicians' intentions to use collaboration and daily routines, whereas attitudes and descriptive norms, but not injunctive norms and self-efficacy, significantly related to clinicians' intentions to use feedback and reflection and problem solving. CONCLUSION These results suggest that implementation strategies should be tailored to the specific intervention component to be most efficient and effective. The results also provide examples of potentially malleable factors that implementation strategies can strategically target.
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Affiliation(s)
- Gwendolyn M Lawson
- Children's Hospital of Philadelphia, 2716 South St, 8th Floor, Philadelphia, Pennsylvania, 19146, United States.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States.
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
| | - Liza Tomczuk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
| | - Jessica Fishman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
- Annenberg School, University of Pennsylvania, Pennsylvania, United States
| | - Steven C Marcus
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
- School of Social Policy and Practice, University of Pennsylvania, Pennsylvania, United States
| | - Melanie Pellecchia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
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Frank HE, Rifkin LS, Sheehan K, Becker-Haimes E, Crane ME, Phillips KE, Palitz SA, Kemp J, Benito K, Kendall PC. Therapist perceptions of experiential training for exposure therapy. Behav Cogn Psychother 2023; 51:214-229. [PMID: 36805734 PMCID: PMC11006093 DOI: 10.1017/s1352465822000728] [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] [Indexed: 02/23/2023]
Abstract
BACKGROUND Despite evidence for its efficacy, exposure therapy for anxiety is rarely used in routine care settings. Efforts to address one major barrier to its use - therapists' negative beliefs about exposure - have included therapist-level implementation strategies, such as training and consultation. Experiential training, in which therapists themselves undergo exposures, has recently demonstrated feasibility, acceptability and preliminary effectiveness for increasing exposure use. AIMS This study aimed to assess: (1) therapists' perceptions of experiential training and (2) barriers and facilitators to implementing exposure following training. METHOD Therapists who underwent experiential training (n=12) completed qualitative interviews and quantitative questionnaires. Interviews were coded using an integrated approach, combining both inductive and deductive approaches. Mixed methods analyses examined how themes varied by practice setting (community mental health versus private practice) and exposure use. RESULTS Results highlight how therapist-level factors, such as clinician self-efficacy, interact with inner- and outer-setting factors. Participants reported positive perceptions of exposure after training; they noted that directly addressing myths about exposure and experiencing exposures themselves improved their attitudes toward exposure. Consistent with prior literature, issues such as insufficient supervisory support, organizational constraints, and client characteristics made it challenging to implement exposures. DISCUSSION Results highlight the benefits of experiential training, while also highlighting the need to consider contextual determinants. Differences in responses across practice settings highlight areas for intervention and the importance of tailoring implementation strategies. Barriers that were specific to therapists who did not use exposure (e.g. hesitancy about its appropriateness for most clients) point to directions for future implementation efforts.
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Affiliation(s)
- Hannah E. Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University
- Bradley Hospital, Lifespan Health System
- Department of Psychology, Temple University
| | | | - Kate Sheehan
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University
- Bradley Hospital, Lifespan Health System
| | - Emily Becker-Haimes
- Department of Psychiatry, University of Pennsylvania
- Hall Mercer Community Mental Health, University of Pennsylvania Health System
| | | | | | | | - Joshua Kemp
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University
- Bradley Hospital, Lifespan Health System
| | - Kristen Benito
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University
- Bradley Hospital, Lifespan Health System
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Lawson GM, Sarno Owens J, Mandell DS, Tavlin S, Rufe S, Power TJ. Exploring Teachers' Intentions to Use Behavioral Classroom Interventions. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2023; 9:78-86. [PMID: 38694789 PMCID: PMC11060708 DOI: 10.1080/23794925.2023.2183434] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Multi-tiered systems of behavioral supports offer teachers tools to implement positive, antecedent- or consequence-based interventions for all students (i.e., Tier 1), and for those who need additional support (i.e., Tier 2), such as students with ADHD. Because these interventions may be challenging to use, targeted, theory-driven implementation strategies may assist teachers in implementing them with fidelity. This exploratory study examined teachers' intended and self-reported use of specific Tier 1 and Tier 2 behavioral classroom interventions. Sixty-five K-8 teachers from five urban public schools completed an online survey about their intentions to use and self-reported use of four Tier 1 and Tier 2 behavioral classroom interventions. Teachers' intentions varied by intervention, with the weakest intentions for using a daily behavior report (Tier 2), and weaker intentions for using high rates of specific praise than for other Tier 1 interventions. Teacher's self-reported use was significantly lower than intended use for Tier 1 interventions, but not Tier 2 interventions. Results were generally similar whether the referent group was students with ADHD symptoms or the entire class. These results suggest specific factors to target to support teachers' use of behavioral classroom interventions.
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Affiliation(s)
- Gwendolyn M Lawson
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - David S Mandell
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Steven Rufe
- Rufe Education Consulting, LLC, Schwenksville, PA
| | - Thomas J Power
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Roudbarani F, Tablon Modica P, Maddox BB, Bohr Y, Weiss JA. Clinician factors related to the delivery of psychotherapy for autistic youth and youth with attention-deficit hyperactivity disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:415-427. [PMID: 35786029 DOI: 10.1177/13623613221106400] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT Autistic children and youth often experience mental health problems, such as anxiety, depression and behavioural challenges. Although there are therapy programmes that have been found helpful in reducing these issues, such as cognitive behaviour therapy, autistic children often struggle to receive adequate mental health care. Clinicians' knowledge, attitudes, confidence and beliefs about treating mental health problems in autistic people may be related to their choices in providing psychotherapy. Across Ontario, Canada, 611 mental health clinicians, working in publicly funded agencies, completed an online survey about their experiences and opinions on delivering therapy for autistic clients compared to those with attention-deficit hyperactivity disorder. Clinician knowledge was associated with their intention to treat autistic clients or clients with attention-deficit hyperactivity disorder, partly because of their attitudes and the social pressures or values they felt. Clinicians reported feeling less intent on providing therapy to autistic youth compared to youth with attention-deficit hyperactivity disorder because of differences in their attitudes, social pressures and knowledge. This research can inform the training and educational initiatives for mental health practitioners.
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Merle JL, Cook CR, Locke JJ, Ehrhart MG, Brown EC, Davis CJ, Lyon AR. Teacher attitudes toward evidence-based practices: Exploratory and confirmatory analyses of the school-adapted evidence-based practice attitude scale. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895221151026. [PMID: 37091537 PMCID: PMC9924278 DOI: 10.1177/26334895221151026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background The Evidence-Based Practice Attitudes Scale (EBPAS) is widely used in implementation research, but it has not been adapted and validated for use among general education teachers, who are most likely to deliver evidence-based prevention programs in schools, the most common setting where youth access social, emotional, and behavioral health services. Method School-based stakeholders and a research team comprised of experts in the implementation of evidence-based practices in schools adapted the EBPAS for teachers (the S-EBPAS). The adapted instrument was administered to a representative sample ( n = 441) of general education teachers (grades K—5) to assess the reliability and internal consistency via factor analyses. The S-EBPAS included two forms (i.e., EBP-agnostic and EBP-specific item referents), therefore, a multiple-group confirmatory factor analysis (CFA) was also performed to establish measurement invariance between the two forms. Results After adaptation and refinement, a 9-item, 3-factor structure was confirmed, with the final model supporting three first-order factors that load onto a second-order factor capturing attitudes toward adopting evidence-based practices. Multiple-group CFA analyses of measurement invariance indicated there were no significant differences between the two forms. Conclusions Overall, this study provides a brief, flexible instrument capturing attitudes toward adopting EBPs that has high reliability and internal consistency, which support its use among general education teachers in school settings implementing evidence-based practices. Plain Language Summary The Evidence-Based Practice Attitudes Scale (EBPAS) is a popular instrument for measuring attitudes toward evidence-based practices (EBPs). This instrument provides valuable information during implementation initiatives, such as whether providers or front-line implementers have favorable attitudes toward a given practice. The EBPAS has been used in many different settings, such as in community-based mental health clinics, medical hospitals, and in child welfare. However, it's use in schools has been limited, and it has not yet been tested with general education teachers, who are key implementers of evidence-based practices in schools. In order to trust that the scores from an instrument are accurate, it needs to be evaluated when scaling it out to new populations and settings. One popular method to determine this is to use factor analysis, which was employed in this study. This study fills the identified gap by assessing the reliability (i.e., accuracy) and internal consistency of the EBPAS among a representative sample of general education teachers. Findings from this study indicate that the school-adapted EBPAS (S-EBPAS) is a brief, nine-item instrument that provides a reliable estimate of teachers’ attitudes toward evidence-based practices. Our results also provide evidence that the S-EBPAS can be used to capture attitudes toward specific EBPs as well as attitudes toward EBP -agnostic. This study provides a flexible instrument that can be used by school-based implementation researchers, practitioners, and intermediaries at multiple phases of implementation projects, such as when exploring a new EBP to adopt.
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Affiliation(s)
- James L. Merle
- Department of Population Health Science, University of Utah, Salt Lake City, UT, USA
| | - Clayton R. Cook
- Department of Organizational Leadership, Policy, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Jill J. Locke
- Department of Psychiatry and Behavior Science, University of Washington, Seattle, WA, USA
| | - Mark G. Ehrhart
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Eric C. Brown
- Department of Public Health Science, University of Miami, Coral Gables, FL, USA
| | - Chayna J. Davis
- Department of Psychiatry and Behavior Science, University of Washington, Seattle, WA, USA
| | - Aaron R. Lyon
- Department of Psychiatry and Behavior Science, University of Washington, Seattle, WA, USA
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Becker-Haimes EM, Klein CC, Frank HE, Oquendo MA, Jager-Hyman S, Brown GK, Brady M, Barnett ML. Clinician Maladaptive Anxious Avoidance in the Context of Implementation of Evidence-Based Interventions: A Commentary. FRONTIERS IN HEALTH SERVICES 2022; 2:833214. [PMID: 36382152 PMCID: PMC9648711 DOI: 10.3389/frhs.2022.833214] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/16/2022] [Indexed: 11/13/2022]
Abstract
This paper posits that a clinician's own anxious reaction to delivering specific evidence-based interventions (EBIs) should be better accounted for within implementation science frameworks. A key next step for implementation science is to delineate the causal processes most likely to influence successful implementation of evidence-based interventions (EBIs). This is critical for being able to develop tailored implementation strategies that specifically target mechanisms by which implementation succeeds or fails. First, we review the literature on specific EBIs that may act as negatively valenced stimuli for clinicians, leading to a process of clinician maladaptive anxious avoidance that can negatively impact EBI delivery. In the following sections, we argue that there are certain EBIs that can cause emotional distress or discomfort in a clinician, related to either: (1) a clinicians' fear of the real or predicted short-term distress the EBI can cause patients, or (2) fears that the clinician will inadvertently cause the patient harm and/or face liability. This distress experienced by the clinician can perpetuate a cycle of maladaptive anxious avoidance by the clinician, contributing to lack of or suboptimal EBI implementation. We illustrate how this cycle of maladaptive anxious avoidance can influence implementation by providing several examples from leading EBIs in the psychosocial literature. To conclude, we discuss how leveraging decades of treatment literature aimed at mitigating maladaptive anxious avoidance can inform the design of more tailored and effective implementation strategies for EBIs that are negatively valenced.
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Affiliation(s)
- Emily M. Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, PA, United States
| | - Corinna C. Klein
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Hannah E. Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, United States
- Bradley Hospital, Lifespan Health System, Riverside, RI, United States
| | - Maria A. Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Shari Jager-Hyman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Gregory K. Brown
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Megan Brady
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Miya L. Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa Barbara, CA, United States
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Fishman J, Yang C, Mandell DS. A review of attitude research that is specific, accurate, and comprehensive within its stated scope: responses to Aarons. Implement Sci 2022; 17:29. [PMID: 35534829 PMCID: PMC9088109 DOI: 10.1186/s13012-022-01200-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Jessica Fishman
- Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA. .,Message Effects Lab at Annenberg School, University of Pennsylvania, 3620 Walnut Street, Philadelphia, PA, 19104, USA.
| | - Catherine Yang
- Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
| | - David S Mandell
- Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
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Hoffacker CP, Klein M, Becker-Haimes EM, Fishman J, Schoenwald SK, Fugo PB, McLeod BD, Dorsey S, Litke S, Shider L, Lieberman A, Mandell DS, Beidas RS. Stakeholder intention to engage in fidelity measurement methods in community mental health settings: A mixed methods study. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221114664. [PMID: 37091084 PMCID: PMC9924256 DOI: 10.1177/26334895221114664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background The current gold standard for measuring fidelity (specifically, adherence) to cognitive behavioral therapy (CBT) is direct observation, a costly, resource-intensive practice that is not feasible for many community organizations to implement regularly. Recent research indicates that behavioral rehearsal (i.e., role-play between clinician and individual with regard to session delivery) and chart-stimulated recall (i.e., brief structured interview between clinician and individual about what they did in session; clinicians use the client chart to prompt memory) may provide accurate and affordable alternatives for measuring adherence to CBT in such settings, with behavioral rehearsal yielding greater correspondence with direct observation. Methods Drawing on established causal theories from social psychology and leading implementation science frameworks, this study evaluates stakeholders’ intention to use behavioral rehearsal and chart-stimulated recall. Specifically, we measured attitudes, self-efficacy, and subjective norms toward using each, and compared these factors across the two methods. We also examined the relationship between attitudes, self-efficacy, subjective norms, and intention to use each method. Finally, using an integrated approach we asked stakeholders to discuss their perception of contextual factors that may influence beliefs about using each method. These data were collected from community-based supervisors ( n = 17) and clinicians ( n = 66). Results Quantitative analyses suggest moderately strong intention to use both methods across stakeholders. There were no differences in supervisors’ or clinicians’ attitudes, self-efficacy, subjective norms, or intention across methods. More positive attitudes and greater reported subjective norms were associated with greater reported intention to use either measure. Qualitative analyses identified participants’ specific beliefs about using each fidelity measure in their organization, and results were organized using the Consolidated Framework for Implementation Research. Conclusions Strategies are warranted to overcome or minimize potential barriers to using fidelity measurement methods and to further increase the strength of intention to use them. Plain Language Summary: The best way to measure fidelity, or how closely a clinician follows the protocol, to Cognitive Behavioral Therapy (CBT) is watching the session. This is an expensive practice that is not feasible for many community organizations to do regularly. Recent research indicates that behavioral rehearsal, or a role-play between the clinician and individual with regard to session delivery, and chart-stimulated recall, or a brief discussion between an individual and the clinician about what they did in session with the clinician having access to the chart to help them remember, may provide accurate and affordable alternatives for measuring fidelity to CBT. We just completed a study demonstrating that both methods are promising, with behavioral rehearsal offering scores that are the most similar to watching the session. Drawing on established theories from social psychology and leading implementation science frameworks, this study evaluates future supervisor and clinician motivation to use these fidelity measurement methods. Specifically, we measured supervisor (n = 17) and clinician (n = 66) attitudes, norms, self-efficacy, intentions, and anticipated barriers and facilitators to using each of these fidelity measurement tools. Quantitative and qualitative analyses suggest similar intention to use both methods, and concerns about barriers to using each method. Further research is warranted to minimize the burden associated with implementing fidelity measurement methods and deploying strategies to increase use.
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Affiliation(s)
- Carlin P. Hoffacker
- Department of Counseling and Educational Psychology, Indiana University, Bloomington, IN, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Melanie Klein
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily M. Becker-Haimes
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Jessica Fishman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Message Effects Lab, Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Perrin B. Fugo
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Bryce D. McLeod
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Shannon Litke
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Lah’Nasia Shider
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Adina Lieberman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - David S. Mandell
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Rinad S. Beidas
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
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Becker-Haimes EM, Mandell DS, Fishman J, Williams NJ, Wolk CB, Wislocki K, Reich D, Schaechter T, Brady M, Maples NJ, Creed TA. Assessing Causal Pathways and Targets of Implementation Variability for EBP use (Project ACTIVE): a study protocol. Implement Sci Commun 2021; 2:144. [PMID: 34930483 PMCID: PMC8686333 DOI: 10.1186/s43058-021-00245-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background Advancing causal implementation theory is critical for designing tailored implementation strategies that target specific mechanisms associated with evidence-based practice (EBP) use. This study will test the generalizability of a conceptual model that integrates organizational constructs and behavioral theory to predict clinician use of cognitive-behavioral therapy (CBT) techniques in community mental health centers. CBT is a leading psychosocial EBP for psychiatric disorders that remains underused despite substantial efforts to increase its implementation. Methods We will leverage ongoing CBT implementation efforts in two large public health systems (Philadelphia and Texas) to recruit 300 mental health clinicians and 600 of their clients across 40 organizations. Our primary implementation outcomes of interest are clinician intentions to use CBT and direct observation of clinician use of CBT. As CBT comprises discrete components that vary in complexity and acceptability, we will measure clinician use of six discrete components of CBT. After finishing their CBT training, participating clinicians will complete measures of organizational and behavior change constructs delineated in the model. Clinicians also will be observed twice via audio recording delivering CBT with a client. Within 48 h of each observation, theorized moderators of the intention-behavior gap will be collected via survey. A subset of clinicians who report high intentions to use CBT but demonstrate low use will be purposively recruited to complete semi-structured interviews assessing reasons for the intention-behavior gap. Multilevel path analysis will test the extent to which intentions and determinants of intention predict the use of each discrete CBT component. We also will test the extent to which theorized determinants of intention that include psychological, organizational, and contextual factors explain variation in intention and moderate the association between intentions and CBT use. Discussion Project ACTIVE will advance implementation theory, currently in its infancy, by testing the generalizability of a promising causal model of implementation. These results will inform the development of implementation strategies targeting modifiable factors that explain substantial variance in intention and implementation that can be applied broadly across EBPs.
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Affiliation(s)
- Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA. .,Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, PA, USA.
| | - David S Mandell
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Jessica Fishman
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA.,Message Effects Laboratory, Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Courtney Benjamin Wolk
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Katherine Wislocki
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Danielle Reich
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Temma Schaechter
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Megan Brady
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Natalie J Maples
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Torrey A Creed
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
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Frank HE, Last BS, AlRabiah R, Fishman J, Rudd BN, Kratz HE, Harker C, Fernandez-Marcote S, Jackson K, Comeau C, Shoyinka S, Beidas RS. Understanding therapists' perceived determinants of trauma narrative use. Implement Sci Commun 2021; 2:131. [PMID: 34852850 PMCID: PMC8638192 DOI: 10.1186/s43058-021-00231-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/23/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Trauma narratives are a critical, exposure-based component of trauma-focused cognitive-behavioral therapy, yet community therapists rarely use them. Given evidence that intentions to deliver elements of cognitive behavioral therapy vary by component, and that intentions to deliver exposure are the weakest, this study focused specifically on trauma narratives. We drew on a social psychology causal theory (Theory of Planned Behavior (TPB)) and an implementation science framework (the Consolidated Framework for Implementation Research (CFIR)) to glean insight into multilevel influences on trauma narrative use. While the CFIR offers a broad list of factors potentially affecting implementation, the TPB offers causal pathways between individual-level constructs that predict behavior, including the uptake of an evidence-based intervention. The integration of these approaches may provide a more complete understanding of factors affecting therapists' use of TNs. METHODS Therapists (n=65) trained in trauma-focused cognitive behavioral therapy completed a survey about their use of and beliefs about trauma narratives. Content analysis was used to identify common beliefs about trauma narratives. A subset of participants (n=17) completed follow-up qualitative interviews, which were analyzed using an integrated approach informed by the CFIR. RESULTS While most participants reported high intentions to use TNs, nearly half reported that they did not use TNs in the last 6 months. Survey data indicate a number of TPB-related determinants related to using trauma narratives. Qualitative interviews identified CFIR-relevant contextual factors that may influence constructs central to TPB. CONCLUSIONS These results highlight the importance of integrating approaches that address multiple theoretical determinants of therapist behavior, including therapist, organizational, and client factors with causal explanations to explain implementation behavior.
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Affiliation(s)
- Hannah E Frank
- Department of Psychology, Temple University, Philadelphia, PA, USA.
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA.
| | - Briana S Last
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Reem AlRabiah
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jessica Fishman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
| | - Brittany N Rudd
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Psychiatry, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Hilary E Kratz
- Department of Psychology, La Salle University, Philadelphia, PA, USA
| | - Colleen Harker
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Kamilah Jackson
- Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA
- PerformCare New Jersey, Robbinsville, NJ, USA
| | | | - Sosunmolu Shoyinka
- Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, USA
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Fishman J, Yang C, Mandell D. Attitude theory and measurement in implementation science: a secondary review of empirical studies and opportunities for advancement. Implement Sci 2021; 16:87. [PMID: 34521422 PMCID: PMC8438998 DOI: 10.1186/s13012-021-01153-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/16/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Implementation science studies often express interest in "attitudes," a term borrowed from psychology. In psychology, attitude research has an established methodological and theoretical base, which we briefly summarize here. We then review implementation studies designed to measure attitudes and compare their definitions and methods with those from psychology. METHODS A recent review identified 46 studies empirically examining factors associated with implementation. For each of these studies, we evaluated whether authors included attitudes as a construct of interest, and if so, whether and how the construct was defined, measured, and analyzed. RESULTS Most of the articles (29/46 [63%]) mention attitudes as an implementation factor. Six articles include a definition of the construct. Nineteen studies were designed to measure attitudes but lacked clarity in describing how attitudes were measured. Those that explained their measurement approach used methods that differed from one another and from validated methods in social psychology. Few articles described associated analyses or provided results specific to attitudes. Despite the lack of specificity regarding relevant measurement, analysis, and results, the articles often included causal conclusions about the role of attitudes. CONCLUSIONS Attitudes may be an important construct to implementation scientists, but studies to date are ambiguous in their definitions of attitudes and inconsistent in the methods used to measure and analyze attitudes. We discuss how implementation studies can apply psychology's standardized definitions, validated measurement approaches, and causal models that include attitudes. This application of attitude theory and methods could offer implementation research valuable scientific opportunities.
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Affiliation(s)
- Jessica Fishman
- Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA.
| | - Catherine Yang
- Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA
| | - David Mandell
- Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA
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Hugh ML, Johnson LD, Cook C. Preschool teachers' selection of social communication interventions for children with autism: An application of the theory of planned behavior. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:188-200. [PMID: 34128400 DOI: 10.1177/13623613211024795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Preschool special educators' are more likely to choose an educational practice to teach a young child with autism a social communication skill if they have positive beliefs about it. We asked preschool special educators to read a description of an autistic student and their social communication goal and imagine they were the student's teacher. We then asked them to pick one of five practices to teach the student. We also asked them questions to understand their attitudes about, confidence in their ability to use, and their perception of their coworkers' support of each practice. There are many research-based practices that a teacher could use to help children learn, and preschool teachers often make these decisions for their students. Teachers' beliefs varied in how supportive they were of each practice, and research shows people are more likely to do something that their beliefs support. In this study, they had more supportive beliefs and were more likely to use some practices, like naturalistic intervention, than other practices, like discrete trial teaching. By knowing this, researchers can help teachers use practices that their beliefs support and help change teachers' beliefs to be supportive of a practice they may need to use.
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Affiliation(s)
- Maria L Hugh
- University of Minnesota, USA.,University of Washington, USA
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Mixed-Method Examination of Latinx Teachers' Perceptions of Daily Behavioral Report Card Interventions to Support Students with ADHD. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:29-43. [PMID: 33977337 DOI: 10.1007/s10488-021-01140-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2021] [Indexed: 10/21/2022]
Abstract
Daily behavioral report cards (DRC) are an efficacious intervention for children with ADHD, yet there is little information on Latinx teachers' perceptions about ADHD and preferences related to behavioral treatment. The purpose of the current study was to examine the feasibility and acceptability of behavioral consultation with Latinx teachers and students, with a particular focus on the DRC. Participants (n = 23) included elementary school teachers (100% Hispanic/Latinx, 96% female) working with predominantly Hispanic/Latinx students. We leveraged a convergent, mixed-method design to evaluate feasibility, acceptability, as well as several potentially associated factors (i.e., perceptual, practical/logistical, individual, and cultural factors). Quantitative and qualitative measures and analyses were guided by the Consolidated Framework for Intervention Research. We found that Latinx teachers' Daily Report Card (DRC) completion rates (80%) were comparable to previous studies with predominantly non-Latinx white teachers and students. Quantitative indicators of acceptability were also similar to the prior literature. Few variables were associated with DRC completion rates, with the exception of teacher self-report of stress and satisfaction, which were both positively associated with completion rates. Qualitative findings expanded quantitative trends; thematic analyses revealed two overarching themes, that (1) teachers' attitudes toward behavioral interventions matter a great deal, and that (2) teachers' perceived behavioral control over DRC implementation depends a lot on the environment. Findings highlight the importance of stakeholders' perspectives, including teachers, in translating research to practice in real world settings.
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Larson M, Cook CR, Brewer SK, Pullmann MD, Hamlin C, Merle JL, Duong M, Gaias L, Sullivan M, Morrell N, Kulkarni T, Weeks M, Lyon AR. Examining the Effects of a Brief, Group-Based Motivational Implementation Strategy on Mechanisms of Teacher Behavior Change. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 22:722-736. [PMID: 33226575 DOI: 10.1007/s11121-020-01191-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 11/27/2022]
Abstract
Training and consultation are core implementation strategies used to support the adoption and delivery of evidence-based prevention programs (EBPPs), but are often insufficient alone to effect teacher behavior change. Motivational interviewing (MI) and related behavior change techniques (e.g., strategic education, social influence, implementation planning) delivered in a group format offer promising supplements to training and consultation to improve EBPP implementation. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a theoretically informed, motivational implementation strategy delivered in a group format prior to and immediately after EBPP training. The purpose of this study was to examine the proximal effects of BASIS-T on hypothesized mechanisms of behavior change (e.g., attitudes, subjective norms, intentions to implement) in the context of teachers receiving training and consultation to implement the Good Behavior Game. As part of a pilot trial, 83 elementary school teachers from 9 public elementary schools were randomly assigned (at the school-level to reduce contamination across participants) to a BASIS-T (n = 44) or active comparison control (n = 39) condition, with both conditions receiving Good Behavior Game (GBG) training and consultation. A series of mixed effects models revealed meaningful effects favoring BASIS-T on a number of hypothesized mechanisms of behavior change leading to increased motivation to implement GBG. The implications, limitations, and directions for future research on the use of MI with groups of individuals and other behavior change techniques to increase the yield of training and consultation are discussed.
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Affiliation(s)
- Madeline Larson
- University of Minnesota, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA.
| | - Clayton R Cook
- University of Minnesota, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA
| | - Stephanie K Brewer
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Michael D Pullmann
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Corinne Hamlin
- University of Minnesota, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA
| | - James L Merle
- University of Minnesota, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA
| | - Mylien Duong
- Committee for Children, 2815 Second Ave., Suite 400, Seattle, WA, 98121, USA
| | - Larissa Gaias
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Margaret Sullivan
- University of Minnesota, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA
| | - Nicole Morrell
- University of Minnesota, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA
| | - Tara Kulkarni
- University of Minnesota, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA
| | - Mollie Weeks
- University of Minnesota, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA
| | - Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
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22
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Fishman J, Lushin V, Mandell DS. Predicting implementation: comparing validated measures of intention and assessing the role of motivation when designing behavioral interventions. Implement Sci Commun 2020; 1:81. [PMID: 33005900 PMCID: PMC7523324 DOI: 10.1186/s43058-020-00050-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 06/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Behavioral intention (which captures one's level of motivation to perform a behavior) is considered a causal and proximal mechanism influencing the use of evidence-based practice (EBP). Implementation studies have measured intention differently, and it is unclear which is most predictive. Some use items referring to "evidence-based practice" in general, whereas others refer to a specific EBP. There are also unresolved debates about whether item stems should be worded "I intend to," "I will," or "How likely are you to" and if a single-item measure can suffice. Using each stem to refer to either a specific EBP or to "evidence-based practice," this study compares the ability of these commonly used measures to predict future EBP implementation. The predictive validity is important for causal model testing and the development of effective implementation strategies. METHODS A longitudinal study enrolled 70 teachers to track their use of two EBPs and compare the predictive validity of six different items measuring teachers' intention. The measures differ by whether an item refers to a specific EBP, or to "evidence-based practices" in general, and whether the stem is worded in one of the three ways: "I intend to," "I will," or "How likely are you to." For each item, linear regressions estimated the variance in future behavior explained. We also compared the predictive validity of a single item versus an aggregate of items by inter-correlating the items using different stems and estimating the explained variance in EBP implementation. RESULTS Depending on the EBP and how intention was measured, the explained variance in implementation ranged from 3.5 to 29.0%. Measures that referred to a specific EBP, rather than "evidence-based practices" in general, accounted for more variance in implementation (e.g., 29.0% vs. 8.6%, and 11.3% vs. 3.5%). The predictive validity varied depending on whether stems were worded "I intend to," "I will," or "How likely are you to." CONCLUSIONS The observed strength of the association between intentions and EBP use will depend on how intention is measured. The association was much stronger if an item referred to a specific EBP, rather than EBP in general. To predict implementation, the results support using an aggregate of two or three intention items that refer to the specific EBP. An even more pragmatic measure of intention consisting of a single item can also predict implementation. As discussed, the relationship will also vary depending on the EBP, which has direct implications for causal model testing and the design of implementation strategies.
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Affiliation(s)
- Jessica Fishman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Annenberg School, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Viktor Lushin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - David S. Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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What Motivates Mental Health Clinicians-in-Training to Implement Evidence-Based Assessment? A Survey of Social Work Trainees. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:411-424. [PMID: 30694460 DOI: 10.1007/s10488-019-00923-4] [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: 10/27/2022]
Abstract
Mental health clinicians do not consistently use evidence-based assessment (EBA), a critical component of accurate case conceptualization and treatment planning. The present study used the Unified Theory of Behavior to examine determinants of intentions to use EBA in clinical practice among a sample of Masters' level social work trainees (N = 241). Social norms had the largest effect on intentions to use EBA. Injunctive norms in reference to respected colleagues accounted for the most variance in EBA intentions. Findings differed for respondents over 29 years of age versus younger respondents. Implications for implementation strategies and further research are discussed.
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Pellecchia M, Beidas RS, Mandell DS, Cannuscio CC, Dunst CJ, Stahmer AC. Parent empowerment and coaching in early intervention: study protocol for a feasibility study. Pilot Feasibility Stud 2020; 6:22. [PMID: 32082608 PMCID: PMC7020349 DOI: 10.1186/s40814-020-00568-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 02/04/2020] [Indexed: 12/03/2022] Open
Abstract
Background Parent-mediated early interventions (EI) for children with autism spectrum disorder (ASD) can result in significant improvements in children’s cognitive ability, social functioning, behavior, and adaptive skills, as well as improvements in parental self-efficacy and treatment engagement. The common component to efficacious parent-mediated early interventions for ASD is clinician use of parent coaching and occurs when a clinician actively teaches the parent techniques to improve their child’s functioning. Available evidence suggests that community-based EI clinicians rarely coach parents when working with families of these children, although specific barriers to coaching are unknown. This consistent finding points to the need to develop strategies to improve the use of parent coaching in community EI programs. The purpose of this community-partnered study is to iteratively develop and pilot test a toolkit of implementation strategies designed to increase EI clinicians’ use of parent coaching. Methods This study has four related phases. Phase 1: examine how EI clinicians trained in Project ImPACT, an evidence-based parent-mediated intervention, coach parents of children with ASD. Phase 2: identify barriers and facilitators to clinician implementation of parent coaching by administering validated questionnaires to, and conducting semi-structured interviews with, clinicians, parents, and agency leaders. Phase 3: partner with a community advisory board to iteratively develop a toolkit of implementation strategies that addresses identified barriers and capitalizes on facilitators to improve clinician implementation of evidence-based parent coaching. Phase 4: pilot test the feasibility and effectiveness of the implementation strategy toolkit in improving EI clinicians’ use of parent coaching with nine EI clinicians and parent-child dyads using a multiple-baseline-across-participants single-case design. Discussion Completion of these activities will lead to an in-depth understanding of EI clinicians’ implementation of parent coaching in usual practice following training in an evidence-based parent-mediated intervention, barriers to their implementation of parent coaching, a toolkit of implementation strategies developed through an iterative community-partnered process, and preliminary evidence regarding the potential for this toolkit to improve EI clinicians’ implementation of parent coaching. These pilot data will offer important direction for a larger evaluation of strategies to improve the use of parent coaching for young children with ASD.
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Affiliation(s)
- Melanie Pellecchia
- 1Penn Center for Mental Health, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Floor, Philadelphia, PA 19104, 215-746-1950 USA
| | - Rinad S Beidas
- 1Penn Center for Mental Health, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Floor, Philadelphia, PA 19104, 215-746-1950 USA.,2Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.,3Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI), University of Pennsylvania, Philadelphia, USA
| | - David S Mandell
- 1Penn Center for Mental Health, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Floor, Philadelphia, PA 19104, 215-746-1950 USA
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25
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Wolk CB, Becker-Haimes EM, Fishman J, Affrunti NW, Mandell DS, Creed TA. Variability in clinician intentions to implement specific cognitive-behavioral therapy components. BMC Psychiatry 2019; 19:406. [PMID: 31852471 PMCID: PMC6921500 DOI: 10.1186/s12888-019-2394-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/05/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND CBT comprises many discrete components that vary in complexity, but implementation and training efforts often approach CBT as a single entity. We examined variability in clinician intentions to use different structural and interventional components of CBT for three different clinical groups: clients receiving CBT, clients with depression, and clients with anxiety. METHODS Clinicians (n = 107) trained in CBT completed a one-time electronic survey. Clinicians' intentions were measured using established item stems from social psychology adapted to examine intentions to use six specific CBT components: exposure therapy, cognitive restructuring, behavioral activation, planning homework, reviewing homework, and agenda-setting. RESULTS Intentions were weakest, on average, for exposure. They were strongest, on average, for reviewing homework. A series of ANOVAs with Tukey's post-hoc tests revealed that participants intended to use exposure with clients receiving CBT (p = .015) and clients with anxiety (p < .001) significantly more than for clients with depression. Participants intended to use behavioral activation with clients with depression (p = .01) significantly more than for clients with anxiety. No other intentions to use CBT components differed among these three clinical populations. CONCLUSIONS When studying determinants of CBT use and designing interventions to increase use, implementers should consider that different CBT components may require different implementation strategies. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA.
| | - Emily M. Becker-Haimes
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104 USA ,Hall-Mercer Community Mental Health Center, Philadelphia, PA USA
| | - Jessica Fishman
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104 USA ,0000 0004 1936 8972grid.25879.31Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA ,0000 0004 1936 8972grid.25879.31Annenberg School for Communication, University of Pennsylvania, Philadelphia, USA
| | - Nicholas W. Affrunti
- 0000 0001 1010 7993grid.431691.8National Association of School Psychologists, Bethesda, MD USA
| | - David S. Mandell
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104 USA ,0000 0004 1936 8972grid.25879.31Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Torrey A. Creed
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104 USA
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26
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Lushin V, Mandell D, Beidas R, Marcus S, Nuske H, Kaploun V, Seidman M, Gaston D, Locke J. Trajectories of Evidence Based Treatment for School Children with Autism: What's the Right Level for the Implementation? J Autism Dev Disord 2019; 50:881-892. [PMID: 31797182 DOI: 10.1007/s10803-019-04304-6] [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: 12/01/2022]
Abstract
Evidence-based practices (EBP) for children with autism are under-used in special-education schools. No research compared child-level versus teacher-level influences on EBP use, which could guide implementation strategies. We derived longitudinal profiles of EBP receipt by children (N = 234) in 69 autism-support classrooms, over an academic year. We compared overall impacts of child-level and teacher-level factors on profile membership. Most children received little EBP throughout the year; however substantial subgroups received increasing, and decreasing, doses of EBP. Child-level and teacher-level factors contributed about equally to profile membership. Children's autism symptoms and verbal ability, teachers' EBP skills, training/experience, classroom support, class size, and implementation leadership climate predicted profile membership. Early identification of treatment profiles could facilitate targeted implementation strategies increasing EBP use.
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Affiliation(s)
- Victor Lushin
- Long Island University, Brooklyn, NY, USA. .,Long Island University Brooklyn, School of Health Professions, 1 University Plaza, Room 246, Brooklyn, NY, 11201, USA.
| | | | - Rinad Beidas
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Victor Kaploun
- National Research University Higher School of Economics, St. Petersburg, Russia
| | - Max Seidman
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jill Locke
- University of Washington, Seattle, WA, USA
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Maddox BB, Crabbe SR, Fishman JM, Beidas RS, Brookman-Frazee L, Miller JS, Nicolaidis C, Mandell DS. Factors Influencing the Use of Cognitive-Behavioral Therapy with Autistic Adults: A Survey of Community Mental Health Clinicians. J Autism Dev Disord 2019; 49:4421-4428. [PMID: 31385175 PMCID: PMC6814555 DOI: 10.1007/s10803-019-04156-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cognitive-behavioral therapy (CBT) can improve anxiety and depression in autistic adults, but few autistic adults receive this treatment. We examined factors that may influence clinicians' use of CBT with autistic adults. One hundred clinicians completed an online survey. Clinicians reported stronger intentions (p = .001), more favorable attitudes (p < .001), greater normative pressure (p < .001), and higher self-efficacy (p < .001) to start CBT with non-autistic adults than with autistic adults. The only significant predictor of intentions to begin CBT with clients with anxiety or depression was clinicians' attitudes (p < .001), with more favorable attitudes predicting stronger intentions. These findings are valuable for designing effective, tailored implementation strategies to increase clinicians' adoption of CBT for autistic adults.
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Affiliation(s)
- Brenna B Maddox
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA.
| | - Samantha R Crabbe
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica M Fishman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Autism Discovery Institute at Rady Children's Hospital, San Diego, CA, USA
| | - Judith S Miller
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christina Nicolaidis
- School of Social Work, Portland State University, Portland, OR, USA
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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28
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Lyon AR, Cook CR, Duong MT, Nicodimos S, Pullmann MD, Brewer SK, Gaias LM, Cox S. The influence of a blended, theoretically-informed pre-implementation strategy on school-based clinician implementation of an evidence-based trauma intervention. Implement Sci 2019; 14:54. [PMID: 31146788 PMCID: PMC6543642 DOI: 10.1186/s13012-019-0905-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/16/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Individual-level implementation determinants, such as clinician attitudes, commonly influence the successful adoption of evidence-based practices, but few explicit strategies have been tested with regard to their ability to impact these key mechanisms of change. This paper reports on an initial test of a blended, theoretically informed pre-implementation strategy designed to target malleable individual-level determinants of behavior change. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a brief and pragmatic pre-implementation strategy that uses strategic education, social influence techniques, and group-based motivational interviewing to target implementation attitudes, perceived social norms, perceived behavioral control, and behavioral intentions to implement among mental health clinicians working in the education sector. METHODS As part of a pilot trial, 25 school mental health clinicians were randomized to BASIS (n = 12) or an attention control placebo (n = 13), with both conditions receiving training and consultation in an evidence-based intervention for youth experiencing trauma (the Cognitive Behavioral Intervention for Trauma in Schools). Theorized mechanisms of change (attitudes, perceived social norms, perceived behavioral control, and behavioral intentions) were assessed at baseline, post-training, and 4-month follow-up. Clinician participation in post-training consultation and intervention adoption were also tracked. RESULTS A series of regression models and independent sample t tests indicated that BASIS had significant, medium to large effects on the majority of its proximal mechanisms from baseline to post-training. BASIS was also associated with a greater latency between initial training in the intervention and discontinuation of participation in post-training consultation, with clinicians in the BASIS condition persisting in consultation for an average of 134 days versus 32 days for controls, but this difference was not statistically significant. At 4-month follow-up, most differences in the theorized mechanisms had attenuated, and approximately the same small number of BASIS clinicians adopted the trauma intervention as controls. CONCLUSION Findings suggest that the brief BASIS pre-implementation strategy had a significant influence on its proximal mechanisms of change, but that these changes did not persist over time or translate into adoption of the trauma intervention. Implications for theory refinement, revisions to the BASIS protocol, and next steps for research surrounding individual-level implementation strategies are discussed. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03791281 . Registered 31 December 2018-Retrospectively registered.
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Affiliation(s)
- Aaron R. Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Clayton R. Cook
- University of Minnesota, 250 Education Sciences Bldg, 56 East River Road, Minneapolis, MN 55455 USA
| | - Mylien T. Duong
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
- Committee for Children, 2815 2nd Ave #400, Seattle, WA 98121 USA
| | - Semret Nicodimos
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Michael D. Pullmann
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Stephanie K. Brewer
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Larissa M. Gaias
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Shanon Cox
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
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Williams N, Beidas R. Annual Research Review: The state of implementation science in child psychology and psychiatry: a review and suggestions to advance the field. J Child Psychol Psychiatry 2019; 60:430-450. [PMID: 30144077 PMCID: PMC6389440 DOI: 10.1111/jcpp.12960] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Scientists have developed evidence-based interventions that improve the symptoms and functioning of youth with psychiatric disorders; however, these interventions are rarely used in community settings. Eliminating this research-to-practice gap is the purview of implementation science, the discipline devoted to the study of methods to promote the use of evidence-based practices in routine care. METHODS We review studies that have tested factors associated with implementation in child psychology and psychiatry, explore applications of social science theories to implementation, and conclude with recommendations to advance implementation science through the development and testing of novel, multilevel, causal theories. RESULTS During its brief history, implementation science in child psychology and psychiatry has documented the implementation gap in routine care, tested training approaches and found them to be insufficient for behavior change, explored the relationships between variables and implementation outcomes, and initiated randomized controlled trials to test implementation strategies. This research has identified targets related to implementation (e.g., clinician motivation, organizational culture) and demonstrated the feasibility of activating these targets through implementation strategies. However, the dominant methodological approach has been atheoretical and predictive, relying heavily on a set of variables from heuristic frameworks. CONCLUSIONS Optimizing the implementation of effective treatments in community care for youth with psychiatric disorders is a defining challenge of our time. This review proposes a new direction focused on developing and testing integrated causal theories. We recommend implementation scientists: (a) move from observational studies of implementation barriers and facilitators to trials that include causal theory; (b) identify a core set of implementation determinants; (c) conduct trials of implementation strategies with clear targets, mechanisms, and outcomes; (d) ensure that behaviors that are core to EBPs are clearly defined; and (e) agree upon standard measures. This agenda will help fulfill the promise of evidence-based practice for improving youth behavioral health.
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Affiliation(s)
| | - Rinad Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
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Benjamin Wolk C, Van Pelt AE, Jager-Hyman S, Ahmedani BK, Zeber JE, Fein JA, Brown GK, Gregor CA, Lieberman A, Beidas RS. Stakeholder Perspectives on Implementing a Firearm Safety Intervention in Pediatric Primary Care as a Universal Suicide Prevention Strategy: A Qualitative Study. JAMA Netw Open 2018; 1:e185309. [PMID: 30646398 PMCID: PMC6324366 DOI: 10.1001/jamanetworkopen.2018.5309] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
IMPORTANCE The rate of youth suicide has increased steadily over the past several decades due, in part, to an increase in suicide by firearm. Implementation of evidence-based approaches to increase safe firearm storage practices are important for reducing youth suicide. OBJECTIVE To assess the needs of stakeholders who would be affected by implementing an evidence-based approach to firearm safety promotion-Firearm Safety Check, which includes screening for the presence of firearms in the home, brief motivational interviewing-informed counseling regarding safe firearm storage, and provision of free firearm locks-in pediatric primary care settings. DESIGN, SETTING, AND PARTICIPANTS In this qualitative study, 58 stakeholders were interviewed over a 7-month period across 9 stakeholder groups from 2 large and diverse health systems. Participants included parents of youth; physicians; nurses and nurse practitioners; leaders of pediatric primary care practices, behavioral health, and quality improvement; system leaders; third-party payers; and members of national credentialing bodies. Data analysis were conducted from September 2017 to April 2018. MAIN OUTCOMES AND MEASURES Interview guides were informed by the Consolidated Framework for Implementation Research. An integrated analysis approach was used in which a priori attributes of interest were identified (Consolidated Framework for Implementation Research constructs, eg, intervention characteristics), and an inductive approach was used with regard to new themes that emerged. RESULTS A total of 58 stakeholders were interviewed (mean [SD] age, 48.38 [10.65] years; 27 men and 31 women). Stakeholders indicated that firearm safety promotion is a health system priority and reported favorable perceptions of the Firearm Safety Check approach for suicide prevention. The importance of leveraging existing infrastructures, such as electronic health record systems and brevity, were frequently noted. Distribution of firearm locks was endorsed as the most complicated component to implement. CONCLUSIONS AND RELEVANCE By including multiple service system stakeholder perspectives, these results support the development of implementation strategies to change clinician, organization, and system behaviors around firearm safety promotion in pediatric primary care as a universal suicide prevention strategy.
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Affiliation(s)
- Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Amelia E. Van Pelt
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brian K. Ahmedani
- Henry Ford Health System, Center for Health Policy & Health Services Research and Behavioral Health Services, Detroit, Michigan
| | - John E. Zeber
- Center for Applied Health Research, Baylor Scott & White Health, jointly with Central Texas Veterans Health Care System, Temple
- School of Public Health, University of Massachusetts at Amherst, Amherst
| | - Joel A. Fein
- Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Gregory K. Brown
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Courtney A. Gregor
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Adina Lieberman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rinad S. Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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31
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Ingersoll B, Straiton D, Casagrande K, Pickard K. Community providers' intentions to use a parent-mediated intervention for children with ASD following training: an application of the theory of planned behavior. BMC Res Notes 2018; 11:777. [PMID: 30376890 PMCID: PMC6208120 DOI: 10.1186/s13104-018-3879-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 10/24/2018] [Indexed: 11/20/2022] Open
Abstract
Objectives The theory of planned behavior (TPB) suggests that attitudes, subjective norms, and perceived behavioral control influence intentions to perform a behavior, and that intentions predict behavior. The present studies examined whether the TPB is applicable to community providers’ use of a parent-mediated intervention for children with autism spectrum disorder (ASD) following introductory training and whether TPB constructs can be modified with training. Results Study 1 demonstrated that community providers’ intentions to use the intervention post-training predicted their use of the intervention 6 months later [X2(1) = 8.03, p = .005]. Study 2 found that provider education (β = .23, t = 2.27, p = .025), attitudes (β = .21, t = 2.09, p = .039), and perceived behavioral control (β = .21, t = 2.15, p = .035) were all unique predictors of intentions. There was a significant increase in providers’ ratings of subjective norms (Z = − 2.46, p = .014) and perceived behavioral control (Z = − 7.36, p < .001) from pre- to post-training. Attitudes towards parent-mediated interventions were highly favorable pre-training and did not significantly increase. Results expand on previous findings and demonstrate the applicability of attitudes and perceived behavioral control in understanding community providers’ use of evidence-based practices for children with ASD.
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Affiliation(s)
- Brooke Ingersoll
- Michigan State University, 316 Physics Rd., East Lansing, MI, 48824, USA.
| | - Diondra Straiton
- Michigan State University, 316 Physics Rd., East Lansing, MI, 48824, USA
| | - Karís Casagrande
- Michigan State University, 316 Physics Rd., East Lansing, MI, 48824, USA
| | - Katherine Pickard
- Department of Pediatrics, JFK Partners, University of Colorado, Anschutz Medical Campus, 13121 E. 17th Avenue, Aurora, CO, 80045, USA
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