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Sheikh A, Jacob J, Vostanis P, Ruby F, Spuerck I, Stankovic M, Morgan N, Mota CP, Ferreira R, Eruyar Ş, Yılmaz EA, Fatima SZ, Edbrooke-Childs J. What Should Personalised Mental Health Support Involve? Views of Young People with Lived Experience and Professionals from Eight Countries. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01382-2. [PMID: 38907740 DOI: 10.1007/s10488-024-01382-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 06/24/2024]
Abstract
Research demonstrates that young people value mental health support that is tailored to their needs and preferences, rather than a "one size fits all" offer, which is often not equitably accessible (National Children's Bureau, 2021). Understanding young people's lived experiences across different sociocultural contexts is important. The aim of this research was to conduct an international qualitative study on the views of young people with lived experience and professionals, on proposed aspects of personalised support for anxiety and/or depression. Participatory action focus groups were conducted with N = 120 young people with lived experience of anxiety and/or depression (14-24 years) and with N = 63 professionals in Brazil, India, Kenya, Pakistan, Portugal, South Africa, Turkey, and the United Kingdom. Data were analysed using the rigorous and accelerated data reduction (RADaR) technique. Overall, although some country-specific differences were found in terms of what aspects of support young people found to be most important, individual preferences were considered stronger, furthering the view that support should be personalised to the needs of the individual young person. Young people experiencing anxiety and/or depression should be able to choose for themselves which aspects of support they would prefer in their own care and support plans, with families and mental health professionals providing guidance where appropriate, rather than removing the young person from the decision-making process altogether. It should also be ensured that the aspects of personalised support can be understood by young people and professionals from different contexts, including marginalised and minoritised groups and communities.
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Affiliation(s)
| | - Jenna Jacob
- Anna Freud, 4-8 Rodney Street, London, N1 9JH, UK.
- Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Panos Vostanis
- School of Media, Communication and Sociology, University of Leicester, University Road, Leicester, UK
| | | | - Inga Spuerck
- Euro Youth Mental Health, The Carling Building, Coopers Yard, Off, Market Pl, Hitchin, SG5 1AR, UK
| | - Milos Stankovic
- Euro Youth Mental Health, The Carling Building, Coopers Yard, Off, Market Pl, Hitchin, SG5 1AR, UK
| | - Nicholas Morgan
- Euro Youth Mental Health, The Carling Building, Coopers Yard, Off, Market Pl, Hitchin, SG5 1AR, UK
| | - Catarina Pinheiro Mota
- University of Trás-Os-Montes and Alto Douro, Vila Real, Portugal
- Center for Psychology, University of Porto, Porto, Portugal
| | - Rúben Ferreira
- University of Trás-Os-Montes and Alto Douro, Vila Real, Portugal
| | - Şeyda Eruyar
- Department of Psychology, Necmettin Erbakan University, Köyceğiz, Meram, Konya, 42140, Turkey
| | - Elmas Aybike Yılmaz
- Department of Psychology, Necmettin Erbakan University, Köyceğiz, Meram, Konya, 42140, Turkey
| | - Syeda Zeenat Fatima
- Hussaini Foundation-Child and Adolescent Development Program, Karachi, Pakistan
| | - Julian Edbrooke-Childs
- Anna Freud, 4-8 Rodney Street, London, N1 9JH, UK
- Clinical, Educational and Health Psychology, University College London, London, UK
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2
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Connors EH, Childs AW, Douglas S, Jensen-Doss A. Data-Informed Communication: How Measurement-Based Care Can Optimize Child Psychotherapy. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01372-4. [PMID: 38662178 DOI: 10.1007/s10488-024-01372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/26/2024]
Abstract
Measurement-based care (MBC) research and practice, including clinical workflows and systems to support MBC, are grounded in adult-serving mental health systems. MBC research evidence is building in child and adolescent services, but MBC practice is inherently more complex due to identified client age, the family system and the need to involve multiple reporters. This paper seeks to address a gap in the literature by providing practical guidance for youth-serving clinicians implementing MBC with children and their families. We focus on MBC as a data-informed, client-centered communication process, and present three key strategies to enhance usual care child and adolescent psychotherapy via developmentally-appropriate MBC. These strategies include (1) go beyond standardized measures; (2) lean into discrepancies; and (3) get curious together. Case-based examples drawn from various child-serving settings illustrate these key strategies of MBC in child psychotherapy.
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Affiliation(s)
| | - Amber W Childs
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Susan Douglas
- Department of Leadership, Policy, and Organizations, Vanderbilt University, Peabody College, Nashville, TN, USA
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3
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Bassi E, Bright K, Norman L, Pintson K, Daniel S, Sidhu S, Gondziola J, Bradley J, Fersovitch M, Stamp L, Moskovic K, LaMonica H, Iorfino F, Gaskell T, Tomlinson S, Johnson D, Dimitropoulos G. Perceptions of mental health providers of the barriers and facilitators of using and engaging youth in digital mental-health-enabled measurement based care. Digit Health 2024; 10:20552076241253093. [PMID: 38726214 PMCID: PMC11080807 DOI: 10.1177/20552076241253093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives Increased rates of mental health disorders and substance use among youth and young adults have increased globally, furthering the strain on an already burdened mental health system. Digital solutions have been proposed as a potential option for the provision of timely mental health services for youth, with little research exploring mental health professional views about using such innovative tools. In Alberta, Canada, we are evaluating the implementation and integration of a digital mental health (dMH) platform into existing service pathways. Within this paper we seek to explore mental health professionals' perceptions of the barriers and facilitators that may influence their utilization of digital MH-enabled measurement-based care (MBC) with the youth who access their services. Methods A qualitative, descriptive methodology was used to inductively generate themes from focus groups conducted with mental health professionals from specialized mental health services and primary care networks in Alberta. Results As mental health professionals considered the barriers and facilitators of using dMH with youth, they referenced individual and family barriers and facilitators to consider. Providers highlighted perceived barriers, including: first, cultural stigma, family apprehension about mental health care, and parental access to dMH and MBC as deterrents to providers adopting digital platforms in routine care; second, perceptions of increased responsibility and liability for youth in crisis; third, perception that some psychiatric and neurodevelopmental disorders in youth are not amenable to dMH; fourth, professionals contemplated youth readiness to engage with dMH-enabled MBC. Participants also highlighted pertinent facilitators to dMH use, noting: first, the suitability of dMH for youth with mild mental health concerns; second, youth motivated to report their changes in mental health symptoms; and lastly, youth proficiency and preference for dMH options. Conclusions By identifying professionals' perceptions of barriers and facilitators for youth users, we may better understand how to address misconceptions about who is eligible and appropriate for dMH through training and education.
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Affiliation(s)
- E.M. Bassi
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - K.S. Bright
- School of Nursing and Midwifery, Faculty of Health, Community, and Education, Mount Royal University, Calgary, Alberta, Canada
- Heroes in Mind, Advocacy, and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, College of Health Science, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - L.G. Norman
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - K. Pintson
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - S. Daniel
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - S. Sidhu
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - J. Gondziola
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - J. Bradley
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - M. Fersovitch
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - L. Stamp
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - K. Moskovic
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - H.M. LaMonica
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - F. Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - T. Gaskell
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - S. Tomlinson
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - D.W. Johnson
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - G. Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
- Calgary Eating Disorders Program, Alberta Health Services, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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4
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Solstad SM, Cooper M, Sundet R, Moltu C. Effects and experiences of idiographic patient-reported outcome measures for feedback in psychotherapy: A systematic review and secondary analysis of the empirical literature. Psychother Res 2023:1-14. [PMID: 37990817 DOI: 10.1080/10503307.2023.2283528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023] Open
Abstract
Objective: There is a growing interest in idiographic patient-reported outcome measures (I-PROMs) for routine outcome monitoring (ROM) and clinical feedback (CF) in psychotherapy, but to our knowledge, no systematic reviews of the empirical literature. Method: We conducted a systematic literature search for empirical papers investigating effects and experiences of I-PROMs for ROM/CF and found a total of 13 papers. There was only one experimental controlled effectiveness study. Results: We formulated a narrative summary of the data set as a whole. We conducted a secondary analysis of nine papers containing qualitative data on stakeholder experiences with I-PROMs and found three superordinate themes and eight subthemes, summarized as "I-PROMs can facilitate self-reflection for patients, assist in identifying and tracking therapeutic topics, and make patients more committed to therapy by giving them a greater sense of responsibility and empowerment. Formulating goals and problems can be difficult, and lack of progress can be demotivating. Time in therapy is precious and must be spent wisely. Effective use of I-PROMs is facilitated by flexibility and therapists' use of clinical skills." Conclusion: We discuss the limitations of the study and provide recommendations for future research and clinical practice.
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Affiliation(s)
| | - Mick Cooper
- School of Psychology, University of Roehampton, London, UK
| | - Rolf Sundet
- University of South-Eastern Norway, Borre, Norway
| | - Christian Moltu
- District General Hospital of Førde, Førde, Norway
- Western Norway University College of Applied Sciences, Førde, Norway
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5
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Lavik KO, Veseth M, Frøysa H, Stefansen J, Nøtnes JC, Moltu C. This is what I need a clinical feedback system to do for me: A qualitative inquiry into perspectives of adolescents and their therapists. J Clin Psychol 2023; 79:729-747. [PMID: 33320330 DOI: 10.1002/jclp.23100] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 10/13/2020] [Accepted: 11/29/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Routine outcome monitoring and clinical feedback systems might be beneficial for adolescent psychotherapy processes. METHODS Clinicians (n = 34) and adolescent clients (n = 22) aged 14-19 from seven different outpatient clinics located in Norway participated in the study. Adolescents were interviewed in individual in-depth interviews (n = 7) or in four adolescent-only focus groups (n = 15), clinicians participated in seven clinician-only focus groups. RESULTS We report two core domains, (1) feedback about the therapeutic relationship and (2) feedback about the therapeutic work. Seven subthemes specify the functionality that participants need in a feedback system. CONCLUSION Adolescents and therapists requested a feedback system that was relationally oriented, supported collaborative action, and was personalized to the needs of the individual adolescent. The research indicates that a clinical feedback system should have idiographic, as well as nomothetic, components. A clinical feedback system for adolescents should monitor experiences of personal autonomy and the quality of the therapeutic relationship.
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Affiliation(s)
- Kristina O Lavik
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway.,Department of Health and Caring Sciences, Western Norway University of Applied Science, Førde, Norway
| | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Helga Frøysa
- Department of Psychology Services, Askøy Commune, Bergen, Norway
| | - Jon Stefansen
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Jan C Nøtnes
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway.,Department of Health and Caring Sciences, Western Norway University of Applied Science, Førde, Norway
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6
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Jacob J, Edbrooke-Childs J, Costa da Silva L, Law D. Notes from the youth mental health field: Using movement towards goals as a potential indicator of service change and quality improvement. J Clin Psychol 2023; 79:697-710. [PMID: 34114660 DOI: 10.1002/jclp.23195] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/16/2021] [Accepted: 05/30/2021] [Indexed: 11/09/2022]
Abstract
The aim of this paper is to report our notes from the field on using movement toward goals at an aggregate level as an inference of service effectiveness. Analysis of routinely collected data from UK youth mental health services was conducted (N = 8,172, age M = 13.8, 67% female, 32% male) to explore the impact of including goal-based outcome data in combined calculations of standardized measures based on the principles of reliable change ("measurable change"). Due to the broad nature of standardized measures, inferred validity becomes diluted in any team or service level aggregate analysis. To make inferences that are closer to the person's interpretation of their difficulties, we argue that Idiographic Patient Reported Outcome Measures (I-PROMs) counterbalance these limitations. This is supported by our findings. The measurable change metric is the first step towards enabling national analysis of aggregated I-PROMs. I-PROMs, supplemented by standardized measures should be used to consider service evaluation.
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Affiliation(s)
- Jenna Jacob
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK.,Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Julian Edbrooke-Childs
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK.,Department of Clinical, Educational and Health Psychology, UCL, London, UK.,Evidence Based Practice Unit, Anna Freud Centre, London, UK
| | - Luís Costa da Silva
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK.,Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Duncan Law
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK.,MindMonkey Associates Ltd, London, UK
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7
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Sales CMD, Ashworth M, Ayis S, Barkham M, Edbrooke-Childs J, Faísca L, Jacob J, Xu D, Cooper M. Idiographic patient reported outcome measures (I-PROMs) for routine outcome monitoring in psychological therapies: Position paper. J Clin Psychol 2023; 79:596-621. [PMID: 35194799 DOI: 10.1002/jclp.23319] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/26/2021] [Accepted: 01/09/2022] [Indexed: 11/07/2022]
Abstract
Idiographic patient-reported outcome measures (I-PROMs) are a growing set of individualized tools for use in routine outcome monitoring (ROM) in psychological therapies. This paper presents a position statement on their conceptualization, use, and analysis, based on contemporary evidence and clinical practice. Four problem-based, and seven goal-based, I-PROMs, with some evidence of psychometric evaluation and use in psychotherapy, were identified. I-PROMs may be particularly valuable to the evaluation of psychological therapies because of their clinical utility and their alignment with a patient-centered approach. However, there are several challenges for I-PROMs: how to generate items in a robust manner, their measurement model, methods for establishing their reliability and validity, and the meaning of an aggregated I-PROM score. Based on the current state of the literature, we recommend that I-PROMs are used to complement nomothetic measures. Research recommendations are also made regarding the most appropriate methods for analyzing I-PROM data.
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Affiliation(s)
- Célia M D Sales
- Faculty of Psychology and Education Sciences (FPCEUP), Center for Psychology at the Universidade do Porto (CPUP), University of Porto, Porto, Portugal
| | - Mark Ashworth
- School of Life Course and Population Sciences, King's College London, Guy's Campus, London, United Kingdom, SE1 1UL, UK
| | - Salma Ayis
- School of Life Course and Population Sciences, King's College London, Guy's Campus, London, United Kingdom, SE1 1UL, UK
| | - Michael Barkham
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Julian Edbrooke-Childs
- Anna Freud Centre, Applied Research and Evaluation, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, UK
| | - Luís Faísca
- FCHS & Center for Research in Health Technologies and Information, Universidade do Algarve, Faro, Portugal
| | - Jenna Jacob
- Anna Freud Centre, Applied Research and Evaluation, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, UK
| | - Dan Xu
- Zhejiang University of Technology, Hangzhou, China
| | - Mick Cooper
- Department of Psychology, University of Roehampton, London, UK
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8
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Krause KR, Edbrooke-Childs J, Bear HA, Calderón A, Wolpert M. What treatment outcomes matter most? A Q-study of outcome priority profiles among youth with lived experience of depression. Eur Child Adolesc Psychiatry 2023; 32:123-137. [PMID: 34273026 PMCID: PMC9908724 DOI: 10.1007/s00787-021-01839-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 06/28/2021] [Indexed: 12/16/2022]
Abstract
Interest in youth perspectives on what constitutes an important outcome in the treatment of depression has been growing, but limited attention has been given to heterogeneity in outcome priorities, and minority viewpoints. These are important to consider for person-centred outcome tracking in clinical practice, or when conducting clinical trials targeting specific populations. This study used Q-methodology to identify outcome priority profiles among youth with lived experience of service use for depression. A purposive sample of 28 youth (aged 16-21 years) rank-ordered 35 outcome statements by importance and completed brief semi-structured interviews eliciting their sorting rationales. By-person principal component analysis was used to identify outcome priority profiles based on all Q-sort configurations. Priority profiles were described and interpreted with reference to the qualitative interview data. Four distinct outcome priority profiles were identified: "Relieving distress and experiencing a happier emotional state"; "Learning to cope with cyclical distressing emotional states"; "Understanding and processing distressing emotional states"; and "Reduced interference of ongoing distressing emotional states with daily life". All four profiles prioritised improvements in mood and the ability to feel pleasure but differed in the level of importance assigned to learning coping skills, processing experiences, and the reduced interference of depression with life and identity. As part of a person-centered approach to care delivery, care providers should routinely engage young people in conversation and shared decision-making about the types of change they would like to prioritise and track during treatment, beyond a common core of consensus outcomes.
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Affiliation(s)
- Karolin Rose Krause
- Evidence Based Practice Unit (EBPU), Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK. .,Research Department of Clinical, Research Department of Clinical, University College London, Gower Street, London, WC1E 6BT, UK. .,Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit (EBPU), Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH UK ,Research Department of Clinical, Research Department of Clinical, University College London, Gower Street, London, WC1E 6BT UK
| | - Holly Alice Bear
- Evidence Based Practice Unit (EBPU), Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH UK ,Research Department of Clinical, Research Department of Clinical, University College London, Gower Street, London, WC1E 6BT UK ,Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, M6J 1H4 UK
| | - Ana Calderón
- School of Psychology, Universidad Gabriela Mistral, Avda. Ricardo Lyon 1177, Providencia, Santiago, Chile
| | - Miranda Wolpert
- Research Department of Clinical, Research Department of Clinical, University College London, Gower Street, London, WC1E 6BT UK ,Wellcome Trust, 215 Euston Rd, Bloomsbury, London, NW1 2BE UK
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9
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Hanley T, Prescott J, Sefi A. The Therapeutic Goals Set by University Students in an Anonymous Web-Based Therapy and Support Setting. Front Psychol 2022; 13:745537. [PMID: 36003101 PMCID: PMC9394726 DOI: 10.3389/fpsyg.2022.745537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 05/26/2022] [Indexed: 12/31/2022] Open
Abstract
The interest in student mental health and wellbeing has increased in recent years. Additionally, there is a rising volume of students seeking support. Numerous online resources have been developed to meet this need, including anonymous web-based therapy. To date, there has been little focus upon how students may utilise such a service, and this study examines routine evaluation data (solicited from a Goal-based Outcome Measure) from a United Kingdom based service provider. Over the course of one academic year (2018–2019), 211 students articulated therapeutic goals within Kooth Student, a web-based therapy and support service for individuals in higher education. These goals were examined for key trends. The students identified a total of 625 goals to work on in therapy, with individuals setting an average of three goals each. The most common goals focused upon obtaining additional support within the service and exploring their emotions. The results suggested that female students were more likely to move towards achieving their goals, with goals that did move shifting an average of 7.74 on a 10-point scale. Practical goals that focused upon getting more help, both inside and outside the service, were most likely to be achieved. In contrast, self-help/self-care goals were less likely to be achieved. These results provide a helpful insight into how students made use of therapy and highlight the importance of the interaction that web-based services have with other provision (web-based and in-person). They also demonstrate the challenge of capturing meaningful outcome data in anonymous services.
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Affiliation(s)
- Terry Hanley
- Manchester Institute of Education, University of Manchester, Manchester, United Kingdom
- Correspondence: Terry Hanley,
| | - Julie Prescott
- Department of Psychology, School of Education and Psychology, University of Bolton, Bolton, United Kingdom
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10
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Jacob J, Edbrooke-Childs J, Flannery H, Segal TY, Law D. Goal-based measurement in paediatric settings: implications for practice. Arch Dis Child 2022; 108:344-348. [PMID: 35680402 DOI: 10.1136/archdischild-2021-322761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 05/13/2022] [Indexed: 11/04/2022]
Abstract
There is an observed link between physical illness and mental health difficulties and an increased likelihood of mental health difficulties in young people with chronic health conditions. The main outcome focus in paediatric settings is on physical health outcomes and functioning. In terms of functioning, the focus is on quality of life, measures of emotional well-being and perceptions of personal change, which are likely to be multifaceted and vary between patients. To complement standardised and diagnostically based measures, goal-based outcome measurement may be considered. The aim of this paper is to build on previous research, to provide a reflective commentary based on the authors' clinical and research experience in the use and interpretation of goal-based outcomes, to address what using goal-based measures for outcome purposes in these settings means practically. Examples are provided to demonstrate the importance of considering meaningful outcomes of importance to young people and how professionals may presume that physical 'recovery' is the goal of treatment, but what recovery means to that young person may be very nuanced. Further key considerations and suggested phrasing are given to introduce and work with young people's goals.
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Affiliation(s)
- Jenna Jacob
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Julian Edbrooke-Childs
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK.,Clinical, Educational and Health Psychology, UCL, London, UK
| | - Halina Flannery
- Psychological Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Terry Y Segal
- Paediatric Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Duncan Law
- Clinical, Educational and Health Psychology, UCL, London, UK.,MindMonkey Associates, London, UK
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11
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Monitoring and Measurement in Child and Adolescent Mental Health: It's about More than Just Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084616. [PMID: 35457484 PMCID: PMC9024737 DOI: 10.3390/ijerph19084616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/04/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022]
Abstract
Routine outcome monitoring (ROM) provides information to practitioners and others providing healthcare support to demonstrate the impact of interventions and for service evaluation [...].
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12
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Krause KR, Edbrooke-Childs J, Singleton R, Wolpert M. Are We Comparing Apples with Oranges? Assessing Improvement Across Symptoms, Functioning, and Goal Progress for Adolescent Anxiety and Depression. Child Psychiatry Hum Dev 2022; 53:737-753. [PMID: 33826029 PMCID: PMC9287244 DOI: 10.1007/s10578-021-01149-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 12/16/2022]
Abstract
Strategies for comparing routinely collected outcome data across services or systems include focusing on a common indicator (e.g., symptom change) or aggregating results from different measures or outcomes into a comparable core metric. The implications of either approach for judging treatment success are not fully understood. This study drew on naturalistic outcome data from 1641 adolescents with moderate or severe anxiety and/or depression symptoms who received routine specialist care across 60 mental health services in England. The study compared rates of meaningful improvement between the domains of internalizing symptoms, functioning, and progress towards self-defined goals. Consistent cross-domain improvement was observed in only 15.6% of cases. Close to one in four (24.0%) young people with reliably improved symptoms reported no reliable improvement in functioning. Inversely, one in three (34.8%) young people reported meaningful goal progress but no reliable symptom improvement. Monitoring systems that focus exclusively on symptom change risk over- or under-estimating actual impact, while aggregating different outcomes into a single metric can mask informative differences in the number and type of outcomes showing improvement. A move towards harmonized outcome measurement approaches across multiple domains is needed to ensure fair and meaningful comparisons.
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Affiliation(s)
- Karolin Rose Krause
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK.
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK.
| | - Julian Edbrooke-Childs
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK
| | - Rosie Singleton
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK
| | - Miranda Wolpert
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
- Wellcome Trust, 215 Euston Rd, Bloomsbury, London, NW1 2BE, UK
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13
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Sefi A, Frampton I. Testing, testing, one, two, three: Service user evaluation of three standard measures of mental health and well‐being in an online counselling and support service for children and young people. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Aaron Sefi
- University of Manchester Manchester UK
- School of Psychology University of Exeter Exeter UK
| | - Ian Frampton
- School of Psychology University of Exeter Exeter UK
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Jacob J, Costa da Silva L, Sefi A, Edbrooke‐Childs J. Online counselling and goal achievement: Exploring meaningful change and the types of goals progressed by young people. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jenna Jacob
- Child Outcomes Research Consortium Anna Freud National Centre for Children and FamiliesThe Kantor Centre of Excellence London UK
| | - Luís Costa da Silva
- Child Outcomes Research Consortium Anna Freud National Centre for Children and FamiliesThe Kantor Centre of Excellence London UK
| | | | - Julian Edbrooke‐Childs
- Child Outcomes Research Consortium Anna Freud National Centre for Children and FamiliesThe Kantor Centre of Excellence London UK
- Evidence Based Practice Unit Anna Freud National Centre for Children and Families and University College London London UK
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Abstract
AbstractThis qualitative study considered whether the provision of a framework of potential goals based on Rogers’ idea of the fully functioning person would be of any benefit to therapy clients in their goal setting process. It also considered addressed whether client goal setting was methodologically acceptable to integrative therapists who used Rogers’ non-directive principles as the foundation to their approach. We provided a goal setting instrument to 9 therapists and 23 of their clients, enabling them to define therapy goals, and feedback on the process. The clients set their goals using the instruments, before having at least six sessions with their therapist. We then sought joint views on the process from the therapists through a questionnaire or an interview. The data from the responses were analyzed using Thematic Analysis. The majority of the therapists considered that guided goal setting using a description of the ‘fully functioning’ individual was helpful. In terms of the applicability of goal setting to an integrative approach based on non-directive, person-centered principles, the results were mixed and in some cases contrary to those expected. For example, some of the more directive therapists disliked guided goal setting processes, whilst the more non-directive therapists appreciated the approach.
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Cooke M, Richards J, Tjondronegoro D, Raj Chakraborty P, Jauncey-Cooke J, Andresen E, Theodoros J, Paterson R, Schults J, Raithatha B, Wilson S, Alcock M. myPainPal: Co-creation of a mHealth app for the management of chronic pain in young people. Inform Health Soc Care 2021; 46:291-305. [PMID: 33784952 DOI: 10.1080/17538157.2021.1892697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chronic pain is common in young people aged 10-14 years. Interdisciplinary, clinician-delivered treatments, while effective, are often criticized for failing to be readily accessible. Mobile health applications (mHealth apps) have been proposed as effective treatment adjuncts that address these challenges, while meeting the needs of tech-savvy young people. The objectives of this study were to co-create a mHealth app with consumers and health care professionals and evaluate the acceptability and feasibility of the resulting mHealth app (myPainPal). A phased, qualitative approach within a consumer engagement framework was employed. Interviews with young people (n = 14), parents (n = 12) and health care professionals (n = 8) identified key health needs that formed the underlying structure of the myPainPal app. Testing showed that the app is an acceptable and feasible platform to facilitate young people's self-management of chronic pain. The myPainPal app has the potential to positively influence young people's experiences of chronic pain. Further testing in controlled settings is required.
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Affiliation(s)
- Marie Cooke
- Griffith University, Menzies Health Institute Queensland, Brisbane, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Julianne Richards
- Queensland Interdisciplinary Paediatric Persistent Pain Service (QIPPPS), Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | | | | | | | - Elizabeth Andresen
- Queensland Interdisciplinary Paediatric Persistent Pain Service (QIPPPS), Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Joanne Theodoros
- Queensland Interdisciplinary Paediatric Persistent Pain Service (QIPPPS), Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Rebecca Paterson
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Psychology, The University of Queensland, Brisbane, Australia
| | - Jessica Schults
- Griffith University, Menzies Health Institute Queensland, Brisbane, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Brisbane, Australia
| | - Bhavesh Raithatha
- Queensland Interdisciplinary Paediatric Persistent Pain Service (QIPPPS), Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Susan Wilson
- Queensland Interdisciplinary Paediatric Persistent Pain Service (QIPPPS), Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Mark Alcock
- Queensland Interdisciplinary Paediatric Persistent Pain Service (QIPPPS), Children's Health Queensland Hospital and Health Service, Brisbane, Australia
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17
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Duckett TR, Fox C, Hart JM, Norte GE. Rationale for a Parsimonious Measure of Subjective Knee Function after ACL Reconstruction: A Rasch Analysis. J Athl Train 2021; 56:1340-1348. [PMID: 33626140 DOI: 10.4085/490-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation is the most frequently used patient-reported measure of subjective knee function among individuals with ACL reconstruction (ACLR). Yet, limitations with traditional validation approaches leave it unclear whether the IKDC measures knee function as intended. Rasch analysis offers a robust validation approach, which may enhance clinical interpretation of the IKDC. OBJECTIVE 1) To assess the psychometric properties, 2) ability to classify health status, and 3) relationships between the IKDC and objective measures of strength and functional performance relative to a newly proposed reduced-item instrument. DESIGN Cross-sectional. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Seventy-seven individuals with primary, unilateral ACLR (21.9±7.8 years, 6.2±1.0 months post-surgery), and seventy-six age-matched controls. MAIN OUTCOME MEASURE(S) Rasch analysis was used to assess the psychometric properties of the IKDC. Receiver-operator-characteristic curves and logistic regression were used to assess the accuracy of classifying ACLR versus control participants. Correlations (Pearson and Spearman) were used to assess relationships between subjective knee function, quadriceps torque, and single-limb hop performance. RESULTS Rasch analysis aided the development of a reduced 8-item instrument (IKDC-8), which yielded improved psychometric properties in misfit analysis, percent of variance accounted for by one dimension (IKDC-8=71.5%; IKDC=56.7%), and item reliability. The IKDC was an outstanding diagnostic tool and the IKDC-8 was excellent, correctly classifying 87.2% and 82.7% of cases, respectively. The Hanley-McNeil formula found that there was no significant difference in the areas under the respective ROC curves. Equivalent associations between subjective and objective knee function were observed regardless of instrument used. CONCLUSIONS We observed evidence of enhanced reliability and validity for a parsimonious measure of subjective knee function. The proposed instrument reduces the number of items, increases score interpretability as measuring a single construct, and improves the rating scale functioning, while not significantly diminishing its ability to classify ACLR versus control participants or changing existing relationships with objective measures of recovery. We suggest the IKDC-8 may enhance clinical use by reducing administration time, improving the interpretation of the subjective knee function score, and clarifying functional ability.
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Affiliation(s)
- T Ryan Duckett
- University of Toledo, Department of Educational Research and Measurement, Toledo, OH
| | - Christine Fox
- University of Toledo, Department of Educational Research and Measurement, Toledo, OH
| | - Joseph M Hart
- University of Virginia, Kinesiology Department, Sports Medicine Program, Charlottesville, VA
| | - Grant E Norte
- University of Toledo, School of Exercise Science and Rehabilitation, Athletic Training Program, Toledo, OH
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Flannery H, Jacob J. Measuring psychological outcomes in paediatric settings: Making outcomes meaningful using client-defined perspectives. Clin Child Psychol Psychiatry 2020; 25:594-603. [PMID: 32046508 DOI: 10.1177/1359104520904120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a growing drive to develop and implement patient-reported outcome measures within paediatric health services, particularly for young people living with chronic health conditions; however, there is little consensus on how best to do this in meaningful ways within psychological services working alongside medical teams. This reflective commentary considers some of the challenges of collecting psychological outcome measures in paediatric services and considers alternative approaches to making outcome measurement meaningful. All measures have their limitations; however, they become meaningless if they are not used in meaningful and considered ways with young people. Client-defined outcome measurement, such as goal-based outcome measures, alongside other types of measurement, can capture outcomes of meaning to young people living with chronic health conditions, and can enable them to feed into a shared decision-making process.
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Affiliation(s)
- Halina Flannery
- Child and Adolescent Psychology Team, Paediatric and Adolescent Division, University College London Hospitals NHS Foundation Trust, UK
| | - Jenna Jacob
- Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, University College London, UK
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Review: What Outcomes Count? A Review of Outcomes Measured for Adolescent Depression Between 2007 and 2017. J Am Acad Child Adolesc Psychiatry 2019; 58:61-71. [PMID: 30577940 DOI: 10.1016/j.jaac.2018.07.893] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/03/2018] [Accepted: 08/15/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Measurement of treatment outcomes in childhood depression has traditionally focused on assessing symptoms from the clinician's perspective, without exploring other outcome domains or considering young people's perspectives. This systematic review explored the extent to which multidimensional and multi-informant outcome measurements have been used in clinical research for adolescent depression in the past decade and how patterns have evolved over time. METHOD Embase, Medline, and PsycINFO were searched, and studies that were published from 2007 through 2017 and assessed the effectiveness of treatments or service provision for adolescent depression were included. Of 7,483 studies screened, 95 met the inclusion criteria and were included for data extraction and analysis. RESULTS Ten outcomes domains were identified, 2 of which were assessed on average using 4 outcome measures. Most studies (94%) measured symptoms, followed by functioning (52%). Other domains such as personal growth, relationships, quality of life, and service satisfaction were each considered by less than 1 in 10 studies. Youth self-report was considered by 54% but tended to focus on secondary outcomes. Multidimensional and multi-informant measurements were more frequent in studies published since 2015. CONCLUSION Recent clinical research continues to prioritize symptoms measurement based on clinician report and has not yet fully embraced multidimensional and multi-informant approaches. In the context of significant policy shifts toward patient-centered and evidence-based care, measuring what matters most to patients has become a priority, but this is not yet widely reflected in clinical research.
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20
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Fuggle P, Cleridou K. Innovations in Practice: Using clinician-rated outcomes to support improved service decision making in a Child and Adolescent Mental Health Service. Child Adolesc Ment Health 2018; 23:57-60. [PMID: 32677364 DOI: 10.1111/camh.12199] [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: 10/11/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinical outcomes are now routinely collected in most services. However, there is a need to make full use of the information collected in order to improve the use of limited Child and Adolescent Mental Health Service (CAMHS) resources. This paper describes a method of improving service decision making by making the interpretation of outcomes data accessible to frontline staff. METHOD Clinician ratings of child outcomes for 2876 cases were routinely collected between 2009 and 2013 in a single CAMHS service. These outcomes were assessed against seven 'point of entry' and 'treatment' variables. RESULTS Older children, referred by social care and presenting with multiple problems were associated with worse treatment outcomes than other service users. These findings were used to create an accessible Service Evaluation Chart of outcomes, to support discussion and decision making within the service. This process enabled the identification of a group who had particularly poor outcomes and resulted in consideration about service changes to try to improve outcomes for this specific group. CONCLUSIONS Providing clinicians with accessible information about outcomes promotes the likelihood of outcomes being used in service decision making.
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Affiliation(s)
- Peter Fuggle
- Anna Freud National Centre for Children and Families, 12 Maresfield Gardens, London, NW3 5SU, UK
| | - Kalia Cleridou
- Anna Freud National Centre for Children and Families, 12 Maresfield Gardens, London, NW3 5SU, UK
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21
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Wolpert M. Commentary: Why measuring clinical change at the individual level is challenging but crucial - commentary on Jensen and Corralejo (2017). Child Adolesc Ment Health 2017; 22:167-169. [PMID: 32680379 DOI: 10.1111/camh.12228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2017] [Indexed: 11/29/2022]
Abstract
Jensen and Corralejo highlight that most mental health intervention research focuses on the group level rather than individual level. They looked at parent-reported outcomes for up to 24 children and found that individual-level findings appear to tell a less positive story than the more traditional group-level finding. They call for more reporting of outcomes at individual level.
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Affiliation(s)
- Miranda Wolpert
- Child Outcomes Research Consortium and Evidence Based Practice Unit, UCL
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Shafran R, Bennett SD, McKenzie Smith M. Interventions to Support Integrated Psychological Care and Holistic Health Outcomes in Paediatrics. Healthcare (Basel) 2017; 5:E44. [PMID: 28812985 PMCID: PMC5618172 DOI: 10.3390/healthcare5030044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/04/2017] [Accepted: 08/07/2017] [Indexed: 11/16/2022] Open
Abstract
There are strong calls from many national and international bodies for there to be a 'holistic' and integrated approach to the understanding and management of psychological and physical health needs. Such holistic approaches are characterized by the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease. Holistic approaches can impact on mental and physical health and are cost-effective. Several psychological interventions have demonstrated efficacy in improving holistic health outcomes, for example Cognitive Behaviour Therapy, Behavioural Therapies and Problem Solving Therapies. They have shown to impact upon a wide range of outcomes, including psychological distress, pain, physical health, medication adherence, and family outcomes. There is increasing recognition that the holistic goals of the child and family should be prioritised, and that interventions and outcomes should reflect these goals. A focus on holistic goals in therapy can be achieved through a combination of personalised goal-based outcomes in addition to symptom-based measures.
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Affiliation(s)
- Roz Shafran
- UCL Great Ormond Street Institute of Child Health, 30 Guilford St., London WC1N 1EH, UK.
| | - Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, 30 Guilford St., London WC1N 1EH, UK.
| | - Mhairi McKenzie Smith
- UCL Great Ormond Street Institute of Child Health, 30 Guilford St., London WC1N 1EH, UK.
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23
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Dallos R. Reflections on assessment, diagnosis and formulation. Clin Child Psychol Psychiatry 2017; 22:167-169. [PMID: 28381127 DOI: 10.1177/1359104517700770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bickman L, Lyon AR, Wolpert M. Achieving Precision Mental Health through Effective Assessment, Monitoring, and Feedback Processes : Introduction to the Special Issue. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 43:271-6. [PMID: 26887937 PMCID: PMC4832000 DOI: 10.1007/s10488-016-0718-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St., Suite 100, Seattle, WA, 98115, USA
| | - Miranda Wolpert
- Evidence Based Practice Unit, UCL and the Anna Freud Centre, 12 Maresfield Gardens, London, NW3 5SU, UK.
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