1
|
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.
Collapse
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
| | | |
Collapse
|
2
|
Ruby F, Costa da Silva L, Tait N, Rashid A, Singleton R, Atkins L, Marriot S, Dalzell K, Labno A, Edbrooke-Childs J, Jacob J. Children and young people's mental health outcome measures in paediatrics. Arch Dis Child 2023; 108:271-275. [PMID: 35680404 DOI: 10.1136/archdischild-2020-320852] [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] [Received: 07/14/2021] [Accepted: 05/13/2022] [Indexed: 11/03/2022]
Abstract
Paediatricians are increasingly likely to encounter children and young people with mental health difficulties, either as primary presentations or as comorbidities linked with chronic illnesses. However, paediatricians may have limited training or experience regarding the tools available to identify mental health needs and how to use these tools. The current paper aims to provide a go-to guide for paediatricians when considering the use of mental health and well-being outcome measures, including how to select, administer and interpret measures effectively. It also provides practical guidance on the most common mental health outcome measures used in children and young people's mental health services across the UK and elsewhere, which paediatricians are likely to encounter in their practice. Paediatricians may also find these measures useful in their own practice to screen for potential mental health difficulties, monitor the impact of chronic health conditions on a young person's mental health and well-being, or to provide evidence when referring young people to mental health services.
Collapse
Affiliation(s)
- Florence Ruby
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | | | - Nick Tait
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Anisatu Rashid
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Rosie Singleton
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Lee Atkins
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Sally Marriot
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Kate Dalzell
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Angelika Labno
- Evidence Based Practice Unit, Anna Freud Centre and UCL, London, UK
| | - Julian Edbrooke-Childs
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
- Evidence Based Practice Unit, Anna Freud Centre and UCL, London, UK
| | - Jenna Jacob
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| |
Collapse
|
3
|
Lassen RB, Abild CB, Kristensen K, Kristensen LJ, Hørlück JT, Jensen AL. Involving children and adolescents with type 1 diabetes in health care: a qualitative study of the use of patient-reported outcomes. J Patient Rep Outcomes 2023; 7:20. [PMID: 36862233 PMCID: PMC9981819 DOI: 10.1186/s41687-023-00564-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Within pediatric health care services, Patient-reported Outcomes (PROs) regarding the patient's health status are mainly used for research purposes in a chronic care setting. However, PROs are also applied in clinical settings in the routine care of children and adolescents with chronic health conditions. PROs have the potential to involve patients because they 'place the patient at the center' of his or her treatment. The investigation of how PROs are used in the treatment of children and adolescents and how this use can influence the involvement of these patients is still limited. The aim of this study was to investigate how children and adolescents with type 1 diabetes (T1D) experience the use of PROs in their treatment with a focus on the experience of involvement. RESULTS Employing Interpretive Description, 20 semi-structured interviews were conducted with children and adolescents with T1D. The analysis revealed four themes related to the use of PROs: Making room for conversation, Applying PROs under the right circumstances, Questionnaire structure and content, and Becoming partners in health care. CONCLUSIONS The results clarify that, to some extent, PROs fulfill the potential they promise, including patient-centered communication, detection of unrecognized problems, a strengthened patient-clinician (and parent-clinician) partnership, and increased patient self-reflection. However, adjustments and improvements are needed if the potential of PROs is to be fully achieved in the treatment of children and adolescents.
Collapse
Affiliation(s)
| | - Caroline Bruun Abild
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Kurt Kristensen
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lene Juel Kristensen
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | | | - Annesofie Lunde Jensen
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
4
|
Lassen RB, Abild CB, Kristensen K, Kristensen LJ, Jensen AL. Patient-reported outcome instruments for assessing the involvement of children and adolescents with type 1 diabetes in their treatment: a scoping review protocol. JBI Evid Synth 2023; 21:609-616. [PMID: 36170118 DOI: 10.11124/jbies-22-00105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to identify available patient-reported outcome instruments used to assess the involvement of children and adolescents with type 1 diabetes in their treatment. Specifically, this review will examine the content, structure, and application of these instruments. INTRODUCTION It is considered meaningful to involve children and adolescents living with a chronic health condition, such as type 1 diabetes, in their own treatment. Despite a growing interest in patient involvement within pediatric health care, including the use of patient-reported outcomes, only a few patient-reported outcome instruments have been developed and are used to evaluate the experiences of children and adolescents with type 1 diabetes of being involved in their own treatment. INCLUSION CRITERIA This scoping review will examine patient-reported outcome instruments used to assess the experiences of children and adolescents (11 to 18 years of age) with type 1 diabetes of being involved in their own care. Patient-reported outcome instruments measuring parents' or clinicians' experiences of involvement will be excluded. METHODS The proposed review will follow JBI guidelines and all stages will involve 2 or more reviewers. PubMed, Embase, CINAHL, PsycINFO, JSTOR, and MedNar will be searched without limitations on the year or language of publication. Literature that is not written in English will be translated. Data extraction, charting, and analysis will be guided by a template developed for this review that focuses on the content, structure, and application of the patient-reported outcome instruments. Any modifications to the extraction template will be detailed in the review, and data will be presented in a descriptive format.
Collapse
Affiliation(s)
| | - Caroline Bruun Abild
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Annesofie Lunde Jensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
5
|
Salvo T, Davison-Jenkins A, Hitchcock M, Daniilidi X, Lambert D. The journey of 'Living with Pain': A feasibility study of the development and running of a collective narrative group. Clin Child Psychol Psychiatry 2023; 28:35-55. [PMID: 35790724 DOI: 10.1177/13591045221112719] [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] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Chronic Pain is increasingly affecting young people, their quality of life and wellbeing including education, social life and mental health. Current Western approaches to psychological support for Chronic Pain often focus on 'pain management' and learning skills and strategies from professionals, making use of Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT) and psychoeducation approaches in individual and group interventions. As a Paediatric Psychology service, we have trialled groups running over multiple weeks informed by these approaches and experienced low attendance rates. METHOD This paper describes a feasibility study of an alternative group intervention; the 'Living with Pain group', which combines the 'Journey of Life' (Denborough, 2014) with collective narrative and liberation psychology approaches. RESULTS Thirty three young people and eight parents / carers attended the intervention. Attendance rates, quantitative and qualitative feedback from one face-to-face group for young people and parents and two online groups for young people showed increased access and acceptability of the group. CONCLUSION The findings from this study have shown that a 1-day collective narrative group intervention is feasible, suitable and acceptable and has increased access to our group intervention. Future directions include co-creation with young people and families, community engagement to increase accessibility of our groups and developing partnerships to respond to young people's hopes to raise awareness.
Collapse
Affiliation(s)
- Tania Salvo
- 8964University College London Hospitals NHS Foundation Trust, UK
| | | | - Megan Hitchcock
- 8964University College London Hospitals NHS Foundation Trust, UK
| | - Xeni Daniilidi
- 8964University College London Hospitals NHS Foundation Trust, UK
| | - Danielle Lambert
- 8964University College London Hospitals NHS Foundation Trust, UK
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Cost-effectiveness of a mental health drop-in centre for young people with long-term physical conditions. BMC Health Serv Res 2022; 22:518. [PMID: 35440005 PMCID: PMC9016208 DOI: 10.1186/s12913-022-07901-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 03/29/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Paediatric patients being treated for long-term physical health conditions (LTCs) have elevated mental health needs. However, mental health services in the community are difficult to access in the usual course of care for these patients. The Lucy Project - a self-referral drop-in access point-was a program to address this gap by enrolling patients for low-intensity psychological interventions during their treatment for LTCs. In this paper, we evaluate the cost-effectiveness of the Lucy Project. METHODS Using a pre-post design, we evaluate the cost-effectiveness of the intervention by calculating the base-case incremental cost-effectiveness ratio (ICER) using outcomes data and expenses recorded by project staff. The target population was paediatric patients enrolled in the program with an average age of 9 years, treated over a time horizon of 6 months. Outcome data were collected via the Paediatric Quality of Life Inventory, which was converted to health utility scores using an instrument found in the literature. The QALYs were estimated using these health utility scores and the length of the intervention. We calculate a second, practical-case incremental cost-effectiveness ratio using streamlined costing figures with maximum capacity patient enrolment within a one-year time horizon, and capturing lessons learned post-trial. RESULTS The base-case model showed an ICER of £21,220/Quality Adjusted Life Years (QALY) gained, while the practical model showed an ICER of £4,359/QALY gained. The practical model suggests the intervention garners significant gains in quality of life at an average cost of £309 per patient. Sensitivity analyses reveal use of staff time was the greatest determinant of the ICER, and the intervention is cost-effective 75% of the time in the base-case model, and 94% of the time in the practical-case model at a cost-effectiveness threshold of £20,000/QALY gained. CONCLUSIONS We find the base-case intervention improves patient outcomes and can be considered cost-effective according to the National Institute for Health and Care Excellence (NICE) threshold of £20,000-£30,000/QALY gained, and the practical-case intervention is roughly four times as cost-effective as the base-case. We recommend future studies incorporate a control group to corroborate the effect size of the intervention.
Collapse
|
8
|
Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, Carr T, de Vries PJ, Dissanayake C, Divan G, Freitag CM, Gotelli MM, Kasari C, Knapp M, Mundy P, Plank A, Scahill L, Servili C, Shattuck P, Simonoff E, Singer AT, Slonims V, Wang PP, Ysrraelit MC, Jellett R, Pickles A, Cusack J, Howlin P, Szatmari P, Holbrook A, Toolan C, McCauley JB. The Lancet Commission on the future of care and clinical research in autism. Lancet 2022; 399:271-334. [PMID: 34883054 DOI: 10.1016/s0140-6736(21)01541-5] [Citation(s) in RCA: 253] [Impact Index Per Article: 126.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Paul Carbone
- Department of Pediatrics at University of Utah, Salt Lake City, UT, USA
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Themba Carr
- Rady Children's Hospital San Diego, Encinitas, CA, USA
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | | | | | | | | | | | - Peter Mundy
- University of California, Davis, Davis, CA, USA
| | | | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Vicky Slonims
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul P Wang
- Simons Foundation Autism Research Initiative, Simons Foundation, New York, NY, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Rachel Jellett
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Szatmari
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | | | | |
Collapse
|
9
|
de Ossorno Garcia S, Salhi L, Sefi A, Hanley T. The Session Wants and Need Outcome Measure: The Development of a Brief Outcome Measure for Single-Sessions of Web-Based Support. Front Psychol 2021; 12:748145. [PMID: 34777142 PMCID: PMC8588807 DOI: 10.3389/fpsyg.2021.748145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
Single-session, brief interventions in therapy for young people make up a large proportion of service provision, including in digital mental health settings. Current nomothetic mental health measures are not specifically designed to capture the benefit or ‘change’ directly related to these brief interventions. As a consequence, we set out to design an outcome measure to concretely demonstrate the value of single-session interventions. The Session Wants and Needs Outcome Measure (SWAN-OM) aims to capture in-session goals and focuses on being user-centric, elements critical to the success of single-session and brief interventions which typically are asset-based and solution-focused. We describe the 4-stage process that was followed to develop this measure: (I) classical item generation and development, (II) content and (III) face validity pilot testing, and (IV) a user-experience approach with young people using framework analysis. This final stage was critical to ensure the integration of this outcome tool into a web-based digital therapy setting, a context which adds another layer of design complexity to item and measure development. This iterative methodology was used to overcome the challenges encountered and to place the needs of the young people and service practitioners at the centre of the design process, thus ensuring measure usability. To end, we highlight the main lessons learnt from engaging in this design process. Specifically, the needs of a measure for single-session interventions are considered, before outlining the learning associated with integrating the measure into a digital mental health platform. Both of these areas are emerging fields and, as such, this study contributes to our understanding of how an idiographic patient outcome theory driven measure can be created for use in a web-based digital mental health therapy service.
Collapse
Affiliation(s)
| | - Louisa Salhi
- Kooth plc, London, United Kingdom.,School of Psychology, University of Kent, Canterbury, United Kingdom
| | - Aaron Sefi
- Kooth plc, London, United Kingdom.,Department of Psychology, University of Exeter, Devon, United Kingdom
| | - Terry Hanley
- School of Environment, Education and Development, The University of Manchester, Manchester, United Kingdom
| |
Collapse
|
10
|
Dovey-Pearce G, Flannery H. Integrating psychology into paediatric healthcare: A UK perspective. Clin Child Psychol Psychiatry 2021; 26:313-322. [PMID: 33761794 DOI: 10.1177/13591045211000786] [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]
Affiliation(s)
| | - Halina Flannery
- Child and Adolescent Psychology Team, Paediatric and Adolescent Division, University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|