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Scheveneels S, De Witte N, Van Daele T. The first steps in facing your fears: The acceptability of virtual reality and in vivo exposure treatment for specific fears. J Anxiety Disord 2023; 95:102695. [PMID: 36921510 DOI: 10.1016/j.janxdis.2023.102695] [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: 08/16/2022] [Revised: 12/29/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
Phobic individuals are often reluctant to engage in exposure in vivo (IVE). We examined whether providing exposure in virtual reality (VRE) can increase the acceptability. In Study 1, we provided 186 fearful participants with (hypothetical) VRE and IVE treatment offers and examined their willingness to engage in treatment, estimated success, negative beliefs, acceptance/refusal and their preference. Almost 70 % preferred VRE over IVE and acceptance rates were higher for the VRE offer (58 %) than for IVE (35 %). Although participants held fewer negative beliefs about VRE, they did rate IVE as slightly more successful. In Study 2, we examined whether VRE can serve as a stepping stone to IVE in a sample of 102 spider fearful individuals. Willingness to engage, estimated success and negative beliefs about IVE were assessed before and after VRE. After VRE, participants rated IVE as more successful, but were not more willing to engage in IVE, nor were they more inclined to accept an IVE offer. No decreases in negative beliefs were observed. In conclusion, VRE is deemed more acceptable than IVE and could lower refusal rates, hereby resulting in more phobic individuals receiving treatment. Future research should shed light on underlying motivations and associations.
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Affiliation(s)
- Sara Scheveneels
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium; Department of Clinical Psychology, Open University of the Netherlands, Heerlen, the Netherlands.
| | - Nele De Witte
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Tom Van Daele
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium; Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
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2
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Lyon AR, Liu FF, Connors EH, King KM, Coifman JI, Cook H, McRee E, Ludwig K, Law A, Dorsey S, McCauley E. How low can you go? Examining the effects of brief online training and post-training consultation dose on implementation mechanisms and outcomes for measurement-based care. Implement Sci Commun 2022; 3:79. [PMID: 35869500 PMCID: PMC9306246 DOI: 10.1186/s43058-022-00325-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 07/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Initial training and ongoing post-training consultation (i.e., ongoing support following training, provided by an expert) are among the most common implementation strategies used to change clinician practice. However, extant research has not experimentally investigated the optimal dosages of consultation necessary to produce desired outcomes. Moreover, the degree to which training and consultation engage theoretical implementation mechanisms-such as provider knowledge, skills, and attitudes-is not well understood. This study examined the effects of a brief online training and varying dosages of post-training consultation (BOLT+PTC) on implementation mechanisms and outcomes for measurement-based care (MBC) practices delivered in the context of education sector mental health services. METHODS A national sample of 75 clinicians who provide mental health interventions to children and adolescents in schools were randomly assigned to BOLT+PTC or control (services as usual). Those in BOLT+PTC were further randomized to 2-, 4-, or 8-week consultation conditions. Self-reported MBC knowledge, skills, attitudes, and use (including standardized assessment, individualized assessment, and assessment-informed treatment modification) were collected for 32 weeks. Multilevel models were used to examine main effects of BOLT+PTC versus control on MBC use at the end of consultation and over time, as well as comparisons among PTC dosage conditions and theorized mechanisms (skills, attitudes, knowledge). RESULTS There was a significant linear effect of BOLT+PTC over time on standardized assessment use (b = .02, p < .01), and a significant quadratic effect of BOLT+PTC over time on individualized assessment use (b = .04, p < .001), but no significant effect on treatment modification. BOLT + any level of PTC resulted in higher MBC knowledge and larger growth in MBC skill over the intervention period as compared to control. PTC dosage levels were inconsistently predictive of outcomes, providing no clear evidence for added benefit of higher PTC dosage. CONCLUSIONS Online training and consultation in MBC had effects on standardized and individualized assessment use among clinicians as compared to services as usual with no consistent benefit detected for increased consultation dosage. Continued research investigating optimal dosages and mechanisms of these established implementation strategies is needed to ensure training and consultation resources are deployed efficiently to impact clinician practices. TRIAL REGISTRATION ClinicalTrials.gov NCT05041517 . Retrospectively registered on 10 September 2021.
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Affiliation(s)
- Aaron R. Lyon
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Freda F. Liu
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Elizabeth H. Connors
- grid.47100.320000000419368710Department of Psychiatry, Yale University, 389 Whitney Avenue, Office 106, New Haven, CT 06511 USA
| | - Kevin M. King
- grid.34477.330000000122986657Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Jessica I. Coifman
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Heather Cook
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Erin McRee
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Kristy Ludwig
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Amy Law
- grid.34477.330000000122986657Graduate Medical Education, University of Washington, Learning Gateway, Box 358220, Seattle, WA 98109 USA
| | - Shannon Dorsey
- grid.34477.330000000122986657Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Elizabeth McCauley
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
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Aarons GA. Reviews of attitude research in implementation science require comprehensiveness, accuracy, and specificity. Implement Sci 2022; 17:28. [PMID: 35534892 PMCID: PMC9084932 DOI: 10.1186/s13012-022-01198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/11/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gregory A Aarons
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093-0812, USA. .,UC San Diego Altman Clinical and Translational Research Institute-Dissemination and Implementation Science Center (UC San Diego ACTRI DISC), 9500 Gilman Drive (0990), La Jolla, CA, 92093-0990, USA. .,Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, 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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O'Hoski S, Harrison SL, Butler S, Goldstein R, Brooks D. Clinician-Led Balance Training in Pulmonary Rehabilitation. Physiother Can 2021; 73:235-243. [PMID: 34456440 DOI: 10.3138/ptc-2019-0111] [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: 11/20/2022]
Abstract
Purpose: Guidelines for pulmonary rehabilitation (PR) include balance training but lack specific parameters. After a knowledge translation project at our site, clinicians modified the physiotherapy programme to facilitate the sustainability of balance training as part of PR. The purpose of this study was to explore whether the modified programme resulted in improved balance and balance confidence. A secondary aim was to provide information on the way in which balance training was operationalized as part of PR for clinicians wanting to incorporate it into an existing PR programme. Method: We conducted a retrospective study of patients with chronic obstructive pulmonary disease, enrolled in a 4- to 6-week inpatient PR programme over a 1-year period. Balance training was provided biweekly with a staff-to-patient ratio of 2:11. Participants completed the brief Balance Evaluation Systems Test (brief-BESTest) and Activities-Specific Balance Confidence (ABC) scale at the beginning and end of PR. Results: The 85 participants had a mean age of 69.5 (SD 9.0) years. After completing an average of 7.6 balance sessions (min-max 2-13), participants showed improvements in brief-BESTest (mean difference 3.2 [95% CI: 2.5, 3.9] points) and ABC (mean difference 7.8 [95% CI: 4.1, 11.5] percent). Conclusions: A staff-to-patient ratio of 2:11 and a training frequency of twice per week for 4-6 weeks improved balance. This result will inform how we incorporate balance training into existing PR programmes.
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Affiliation(s)
- Sachi O'Hoski
- Respiratory Research, West Park Healthcare Centre, Toronto, Ontario, Canada.,School of Rehabilitation Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Samantha L Harrison
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Stacey Butler
- Respiratory Research, West Park Healthcare Centre, Toronto, Ontario, Canada.,Faculty of Medicine, Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Roger Goldstein
- Respiratory Research, West Park Healthcare Centre, Toronto, Ontario, Canada.,Faculty of Medicine, Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Respiratory Research, West Park Healthcare Centre, Toronto, Ontario, Canada.,School of Rehabilitation Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
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6
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School-Based Clinicians Sustained Use of a Cognitive Behavioral Treatment for Anxiety Disorders. SCHOOL MENTAL HEALTH 2020. [DOI: 10.1007/s12310-020-09381-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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7
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A systematic review of empirical studies examining mechanisms of implementation in health. Implement Sci 2020. [PMID: 32299461 DOI: 10.1186/s13012‐020‐00983‐3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the mechanisms of implementation strategies (i.e., the processes by which strategies produce desired effects) is important for research to understand why a strategy did or did not achieve its intended effect, and it is important for practice to ensure strategies are designed and selected to directly target determinants or barriers. This study is a systematic review to characterize how mechanisms are conceptualized and measured, how they are studied and evaluated, and how much evidence exists for specific mechanisms. METHODS We systematically searched PubMed and CINAHL Plus for implementation studies published between January 1990 and August 2018 that included the terms "mechanism," "mediator," or "moderator." Two authors independently reviewed title and abstracts and then full texts for fit with our inclusion criteria of empirical studies of implementation in health care contexts. Authors extracted data regarding general study information, methods, results, and study design and mechanisms-specific information. Authors used the Mixed Methods Appraisal Tool to assess study quality. RESULTS Search strategies produced 2277 articles, of which 183 were included for full text review. From these we included for data extraction 39 articles plus an additional seven articles were hand-entered from only other review of implementation mechanisms (total = 46 included articles). Most included studies employed quantitative methods (73.9%), while 10.9% were qualitative and 15.2% were mixed methods. Nine unique versions of models testing mechanisms emerged. Fifty-three percent of the studies met half or fewer of the quality indicators. The majority of studies (84.8%) only met three or fewer of the seven criteria stipulated for establishing mechanisms. CONCLUSIONS Researchers have undertaken a multitude of approaches to pursue mechanistic implementation research, but our review revealed substantive conceptual, methodological, and measurement issues that must be addressed in order to advance this critical research agenda. To move the field forward, there is need for greater precision to achieve conceptual clarity, attempts to generate testable hypotheses about how and why variables are related, and use of concrete behavioral indicators of proximal outcomes in the case of quantitative research and more directed inquiry in the case of qualitative research.
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8
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Lewis CC, Boyd MR, Walsh-Bailey C, Lyon AR, Beidas R, Mittman B, Aarons GA, Weiner BJ, Chambers DA. A systematic review of empirical studies examining mechanisms of implementation in health. Implement Sci 2020; 15:21. [PMID: 32299461 PMCID: PMC7164241 DOI: 10.1186/s13012-020-00983-3] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/12/2020] [Indexed: 11/15/2022] Open
Abstract
Background Understanding the mechanisms of implementation strategies (i.e., the processes by which strategies produce desired effects) is important for research to understand why a strategy did or did not achieve its intended effect, and it is important for practice to ensure strategies are designed and selected to directly target determinants or barriers. This study is a systematic review to characterize how mechanisms are conceptualized and measured, how they are studied and evaluated, and how much evidence exists for specific mechanisms. Methods We systematically searched PubMed and CINAHL Plus for implementation studies published between January 1990 and August 2018 that included the terms “mechanism,” “mediator,” or “moderator.” Two authors independently reviewed title and abstracts and then full texts for fit with our inclusion criteria of empirical studies of implementation in health care contexts. Authors extracted data regarding general study information, methods, results, and study design and mechanisms-specific information. Authors used the Mixed Methods Appraisal Tool to assess study quality. Results Search strategies produced 2277 articles, of which 183 were included for full text review. From these we included for data extraction 39 articles plus an additional seven articles were hand-entered from only other review of implementation mechanisms (total = 46 included articles). Most included studies employed quantitative methods (73.9%), while 10.9% were qualitative and 15.2% were mixed methods. Nine unique versions of models testing mechanisms emerged. Fifty-three percent of the studies met half or fewer of the quality indicators. The majority of studies (84.8%) only met three or fewer of the seven criteria stipulated for establishing mechanisms. Conclusions Researchers have undertaken a multitude of approaches to pursue mechanistic implementation research, but our review revealed substantive conceptual, methodological, and measurement issues that must be addressed in order to advance this critical research agenda. To move the field forward, there is need for greater precision to achieve conceptual clarity, attempts to generate testable hypotheses about how and why variables are related, and use of concrete behavioral indicators of proximal outcomes in the case of quantitative research and more directed inquiry in the case of qualitative research.
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Affiliation(s)
- Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA. .,Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th Street, Bloomington, IN, 47405, USA. .,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 1959 NE Pacific Avenue, Seattle, WA, 98195, USA.
| | - Meredith R Boyd
- Department of Psychology, University of California Los Angeles, 1177 Franz Hall, 502 Portola Plaza, Los Angeles, CA, 90095, USA
| | - Callie Walsh-Bailey
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.,Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 1959 NE Pacific Avenue, Seattle, WA, 98195, USA
| | - Rinad Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
| | - Brian Mittman
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Avenue, Pasadena, CA, 91101, USA
| | - Gregory A Aarons
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Bryan J Weiner
- Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - David A Chambers
- Division of Cancer Control and Population Science, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
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Accurso EC, Le Grange D, Graham AK. Attitudes Toward Family-Based Treatment Impact Therapists' Intent to Change Their Therapeutic Practice for Adolescent Anorexia Nervosa. Front Psychiatry 2020; 11:305. [PMID: 32390882 PMCID: PMC7192208 DOI: 10.3389/fpsyt.2020.00305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/26/2020] [Indexed: 11/13/2022] Open
Abstract
Community-based clinicians who treat patients with eating disorders rarely use empirically-supported treatments, and research demonstrates that clinicians make significant modifications when implementing family-based treatment (FBT) for anorexia nervosa. This study examined clinician attitudes toward FBT and explored the extent to which attitudes predicted intent to shift practices following training in FBT. Clinicians (N = 129) completed a standardized training in FBT for AN, either a two-day introductory training (n = 99) or a one-day "advanced" training (n = 30). Linear regressions were used to examine the association between therapists' attitudes toward FBT and their intent to use strategies consistent with FBT in the future, adjusting for pre-training use of strategies. Providers reported very positive attitudes toward evidence-based practices in general and moderately positive attitudes toward FBT. There were no significant differences between "novice" and "advanced" providers on attitudes toward evidence-based practices or FBT (ps > .10). For the subset of providers attending their first training in FBT, more positive attitudes toward FBT significantly predicted greater intent to use FBT-consistent strategies (p = .004), and more positive attitudes toward evidence-based practice significantly predicted lesser intent to use FBT-inconsistent strategies (p = .009). This study suggests that both general attitudes toward evidence-based practice and specific attitudes toward FBT may impact implementation. Future research might examine whether a brief intervention to improve attitudes toward FBT might increase the likelihood of seeking expert consultation post-training.
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Affiliation(s)
- Erin C Accurso
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Daniel Le Grange
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL, United States
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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10
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Dimitropoulos G, Lock JD, Agras WS, Brandt H, Halmi KA, Jo B, Kaye WH, Pinhas L, Wilfley DE, Woodside DB. Therapist adherence to family-based treatment for adolescents with anorexia nervosa: A multi-site exploratory study. EUROPEAN EATING DISORDERS REVIEW 2020; 28:55-65. [PMID: 31297906 PMCID: PMC6925617 DOI: 10.1002/erv.2695] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 05/16/2019] [Accepted: 05/27/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This exploratory study is the first to examine family-based treatment (FBT) adherence and association to treatment outcome in the context of a large-scale, multi-centre study for the treatment of adolescents with anorexia nervosa. METHOD One hundred and ninety recorded FBT sessions from 68 adolescents with anorexia nervosa and their families were recruited across multiple sites (N = 6). Each site provided 1-4 tapes per family over four treatment time points, and each was independently rated for therapist adherence. RESULTS There were differences in adherence scores within and between sites. ANOVA produced a main effect for site, F(5, 46) = 8.6, p < .001, and phase, F(3, 42) = 12.7, p < .001, with adherence decreasing in later phases. Adherence was not associated to end of treatment percent ideal body weight after controlling for baseline percent ideal body weight (r = .088, p = .48). CONCLUSIONS Results suggest that FBT can be delivered with adherence in phase one of treatment. Adherence was not associated with treatment outcome as determined using percent ideal body weight.
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Affiliation(s)
| | - James D Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | | | - Harry Brandt
- The Center for Eating Disorders, Sheppard Pratt Health System, Baltimore, MD
| | - Katherine A Halmi
- Department of Psychiatry, Weill Medical College, Cornell University, New York, NY
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Walter H Kaye
- Centre for Eating Disorders, Department of Psychiatry, University of California, San Diego, CA
| | - Leora Pinhas
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - D Blake Woodside
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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11
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Lindholm LH, Koivukangas A, Lassila A, Kampman O. What is important for the sustained implementation of evidence-based brief psychotherapy interventions in psychiatric care? A quantitative evaluation of a real-world programme. Nord J Psychiatry 2019; 73:185-194. [PMID: 30888233 DOI: 10.1080/08039488.2019.1582698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Behavioural activation and motivational interviewing, both evidence-based treatments (EBTs), were implemented in secondary psychiatric care. This longitudinal evaluation of a real-world programme focused on the penetration of EBT adoption and its associations with therapist-related and perceived intervention-related variables. The implementation plan was also compared to sub-processes of Normalization Process Theory. MATERIAL AND METHODS Six participating units employed 72 therapists regularly and they comprise the target group. Due to staff turnover, a total of 84 therapists were trained stepwise. Three survey points (q1, q2, q3) were set for a four-year cycle beginning a year after the initial training and completed 4-5 months after closing patient recruitment. The implementation plan included two workshop days, one for each EBT, and subsequent case consultation groups and other more general strategies. RESULTS Fifty-seven (68%) of programme-trained therapists responded to one or more of three questionnaires. The self-reported penetration covers about a third of the target group a few months after the completion of the programme. Therapists' favourable perceptions of the EBTs regarding relative advantage, compatibility and complexity were associated with their sustained adoption. Therapists' background factors (e.g. work experience) and positive adoption intention at q1 did not predict the actual adoption of the EBTs at q3. No specific sustainment strategies were included in the implementation plan. CONCLUSION Brief but multi-faceted training with subsequent case consultations promoted the adoption of EBTs in a real-world setting. Adding specific sustainment strategies to the implementation plan is proposed to ensure the long-term survival of the implementation outcomes.
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Affiliation(s)
- Lars H Lindholm
- a Department of Psychiatry , South Ostrobothnia Hospital District , Seinäjoki , Finland.,b Faculty of Medicine and Life Sciences , Tampere University , Tampere , Finland
| | - Antti Koivukangas
- a Department of Psychiatry , South Ostrobothnia Hospital District , Seinäjoki , Finland.,b Faculty of Medicine and Life Sciences , Tampere University , Tampere , Finland
| | - Antero Lassila
- a Department of Psychiatry , South Ostrobothnia Hospital District , Seinäjoki , Finland
| | - Olli Kampman
- a Department of Psychiatry , South Ostrobothnia Hospital District , Seinäjoki , Finland.,b Faculty of Medicine and Life Sciences , Tampere University , Tampere , Finland
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Gellatly R, Brookman-Frazee L, Barnett M, Gonzalez JC, Kim JJ, Lau AS. Therapist Reports of EBP Client Engagement Challenges in Sessions with Diverse Youth and Families in Community Mental Health Settings. CHILD & YOUTH CARE FORUM 2019; 48:55-75. [PMID: 32132809 PMCID: PMC7055736 DOI: 10.1007/s10566-018-9472-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The implementation of evidence-based practices (EBPs) in community settings appears to result in reduced benefit relative to controlled trials. This difference in outcomes may be attributable in part to engagement challenges therapists encounter when delivering EBPs to low-income ethnic minority youth and families. OBJECTIVE The current study sought to identify therapist, client, and session characteristics associated with therapist-reported engagement challenges in therapy sessions, as well the associations between two types of client engagement challenges and therapists' self-reported ability to deliver the EBP in sessions within a system-driven implementation in public children's mental health services. METHOD One hundred and three therapists reported on two types of engagement challenges-Limited Client Engagement and Expressed Client Concerns-in 702 sessions with 274 clients. RESULTS Results indicated that therapists reported a higher frequency of Limited Client Engagement in sessions with male clients and in sessions where the youth was present, and by therapists with smaller caseloads. No variables significantly predicted Expressed Client Concerns. Both types of engagement challenges were negatively associated with therapists' report of their ability to carry out intended activities in the same session. CONCLUSIONS Findings suggest that therapists may benefit from learning strategies to address these two distinct types of engagement challenges encountered in implementation of EBPs with diverse families in community settings.
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Affiliation(s)
- R. Gellatly
- University of California, Los Angeles, Los Angeles, CA, USA
| | - L. Brookman-Frazee
- University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - M. Barnett
- University of California, Santa Barbara, Santa Barbara, CA, USA
| | - J. C. Gonzalez
- University of California, Santa Barbara, Santa Barbara, CA, USA
| | - J. J. Kim
- University of California, Los Angeles, Los Angeles, CA, USA
| | - A. S. Lau
- University of California, Los Angeles, Los Angeles, CA, USA
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Reid AM, Guzick AG, Fernandez AG, Deacon B, McNamara JPH, Geffken GR, McCarty R, Striley CW. Exposure therapy for youth with anxiety: Utilization rates and predictors of implementation in a sample of practicing clinicians from across the United States. J Anxiety Disord 2018; 58:8-17. [PMID: 29929139 DOI: 10.1016/j.janxdis.2018.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/02/2018] [Accepted: 06/08/2018] [Indexed: 12/22/2022]
Abstract
Exposure therapy is a highly effective, evidence-based treatment technique for children and adolescents with anxiety disorders. Regardless, therapists in the community are reported to use exposure relatively rarely compared with other approaches. The goal of the present study was to identify how practicing clinicians treat youth with anxiety disorders across the United States and what factors contribute to their use of exposure therapy. Recruited from public directories, 257 private practice therapists who treat anxious youth were surveyed. Non-exposure cognitive-behavioral techniques like cognitive restructuring and relaxation techniques were used significantly more frequently than exposure. Providers with more training in exposure therapy and fewer negative beliefs about this approach reported using exposure significantly more in the treatment of youth with social anxiety, obsessive-compulsive, and panic disorders. Self-identification as an anxiety disorder specialist significantly predicted exposure use for youth with posttraumatic stress disorder. Most therapists in private practice have minimal training in exposure therapy, perceive a lack of training options, and believe there would be a benefit to acquiring more training. The implications of these findings are discussed, including how to optimally design training opportunities in exposure therapy.
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Affiliation(s)
- Adam M Reid
- McLean Hospital, Harvard Medical School, 115 Mill Street, Boston, MA 02478, United States.
| | - Andrew G Guzick
- University of Florida (UF), College of Medicine, 8491 NW 39th Ave, Gainesville, FL, 32606, United States; UF, College of Public Health and Health Professions, 1225 Center Drive, Gainesville, FL 32611, United States.
| | - Alyka Glor Fernandez
- Kansas City University of Medicine and Biosciences, 1750 Independence Ave, Kansas City, MO 64106, United States.
| | - Brett Deacon
- University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Joseph P H McNamara
- University of Florida (UF), College of Medicine, 8491 NW 39th Ave, Gainesville, FL, 32606, United States; UF, College of Public Health and Health Professions, 1225 Center Drive, Gainesville, FL 32611, United States; UF, College of Liberal Arts and Sciences, 945 Center Drive, Gainesville FL, 32611, United States.
| | - Gary R Geffken
- The Geffken Group, 2833 NW 41 St #140, Gainesville, FL, 32606, United States.
| | - Ryan McCarty
- University of Florida (UF), College of Medicine, 8491 NW 39th Ave, Gainesville, FL, 32606, United States; UF, College of Public Health and Health Professions, 1225 Center Drive, Gainesville, FL 32611, United States.
| | - Catherine W Striley
- University of Florida (UF), College of Medicine, 8491 NW 39th Ave, Gainesville, FL, 32606, United States; UF, College of Public Health and Health Professions, 1225 Center Drive, Gainesville, FL 32611, United States.
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14
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Barnett M, Brookman-Frazee L, Regan J, Saifan D, Stadnick N, Lau A. How Intervention and Implementation Characteristics Relate to Community Therapists' Attitudes Toward Evidence-Based Practices: A Mixed Methods Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:824-837. [PMID: 28236076 DOI: 10.1007/s10488-017-0795-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Therapists' perceptions toward evidence-based practices (EBPs) are important in implementation efforts, however little is known about characteristics of EBPs associated with more positive attitudes. This mixed-methods study examined how intervention and implementation characteristics of six EBPs related to therapist attitudes. Quantitative analysis of 793 cross-sectional surveys revealed that therapists endorsed more positive attitudes toward EBPs with (1) prescribed session content and order and (2) required consultation. Associations between these intervention and implementation characteristics and attitudes were not moderated by therapist experience or emotional exhaustion. Qualitative analyses complemented quantitative findings, indicating that "structure" was appealing for interventions and that therapists felt supported by consultation.
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Affiliation(s)
- Miya Barnett
- Department of Counseling, Clinical, & School Psychology, Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA.
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.,Child and Adolescents Service Research Center, San Diego, CA, USA
| | - Jennifer Regan
- Hathaway-Sycamores, Child and Family Services, Pasadena, CA, USA
| | - Dana Saifan
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nicole Stadnick
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.,Child and Adolescents Service Research Center, San Diego, CA, USA
| | - Anna Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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15
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Kim JJ, Brookman-Frazee L, Gellatly R, Stadnick N, Barnett ML, Lau AS. Predictors of Burnout among Community Therapists in the Sustainment Phase of a System-Driven Implementation of Multiple Evidence-Based Practices in Children's Mental Health. ACTA ACUST UNITED AC 2018; 49:131-142. [PMID: 30270968 DOI: 10.1037/pro0000182] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Burnout among community mental health (CMH) therapists has been associated with poorer therapist health, high agency turnover, poorer client outcomes, and compromised quality of care. Recent mandates to learn and implement multiple evidence-based practices (EBPs) within CMH settings are intended to improve the quality of community care, yet there is mixed evidence concerning the impacts on workforce burnout. The current study sought to identify correlates of therapist emotional exhaustion, a key aspect of burnout, during the sustainment phase of a system-driven implementation of multiple EBPs in children's mental health services. We hypothesized that high workload and unfavorable organizational climate would relate to therapist emotional exhaustion, but that positive experiences with EBPs adopted would relate to lower exhaustion. Although agency-level indices of organizational climate were unrelated to exhaustion, a multilevel model revealed that therapists' weekly work hours, caseload, and number of EBPs delivered were associated with increased emotional exhaustion. Additionally, activities associated with the EBP implementation efforts (e.g., hours spent in EBP-related activities, supervision or consultation, or outcome monitoring), were not associated with emotional exhaustion. Therapists' knowledge and confidence delivering EBPs and their positive perceptions of EBPs were protective against emotional exhaustion, but these perceptions did not buffer the risks associated with heavy workload. Findings point to implementation strategies to prevent burnout and associated turnover that compromise the returns on investments in EBP implementation.
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Affiliation(s)
- Joanna J Kim
- University of California Los Angeles, Department of Psychology
| | - Lauren Brookman-Frazee
- University of California San Diego, Department of Psychiatry
- Child and Adolescent Services Research Center
| | - Resham Gellatly
- University of California Los Angeles, Department of Psychology
| | - Nicole Stadnick
- University of California San Diego, Department of Psychiatry
- Child and Adolescent Services Research Center
| | - Miya L Barnett
- University of California, Santa Barbara, Department of Counseling, Clinical & School Psychology
| | - Anna S Lau
- University of California Los Angeles, Department of Psychology
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16
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Post-training Beliefs, Intentions, and Use of Prolonged Exposure Therapy by Clinicians in the Veterans Health Administration. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:123-132. [PMID: 26487392 DOI: 10.1007/s10488-015-0689-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To examine how changes in beliefs during the training process predict adoption of prolonged exposure therapy (PE) by veterans health administration clinicians who received intensive training in this evidence-based treatment. Participants completed a 4-day PE workshop and received expert consultation as they used PE with two or more training cases. Participants were surveyed prior to the workshop, after the workshop, after case consultation (n = 1.034), and 6 months after training (n = 810). Hierarchical regression was used to assess how pre-training factors, and changes in beliefs during different stages of training incrementally predicted post-training intent to use PE and how many patients clinicians were treating with PE 6 months after training. Post-training intent to use PE was high (mean = 6.2, SD = 0.81 on a 1-7 scale), yet most participants treated only 1 or 2 patients at a time with PE. Pre-training factors predicted intent to use and actual use of PE. Changes in beliefs during the workshop had statistically significant yet modest effects on intent and use of PE. Changes in beliefs during case consultation had substantial effects on intent and actual use of PE. Pre-training factors and changes in beliefs during training (especially during case consultation) influence clinicians' adoption of PE. Use of PE was influenced not only by its perceived clinical advantages/disadvantages, but also by contextual factors (working in a PTSD specialty clinic, perceived control over one's schedule, and ability to promote PE to patients and colleagues).
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17
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Becker-Haimes EM, Franklin M, Bodie J, Beidas RS. Feasibility and acceptability of a toolkit to facilitate clinician use of exposure therapy for youth. ACTA ACUST UNITED AC 2017; 2:165-178. [PMID: 30740525 DOI: 10.1080/23794925.2017.1383867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Exposure therapy is a key element of cognitive-behavioral therapy for youth with anxiety. However, few clinicians outside of specialty anxiety clinics routinely use exposures with anxious youth. This study reports on the acceptability and feasibility of a clinician support toolkit for exposures with anxious youth in community settings. The toolkit was developed through an extensive literature review of exposure science and cited barriers to exposure therapy, with input from multiple experts in pediatric anxiety (n = 10). Acceptability and feasibility data was gathered via survey from 70 community clinicians attending a training on exposure therapy for youth. Qualitative data was collected from a subset of participants who used the toolkit with youth on their caseload for approximately one month. Survey data suggested that the toolkit was viewed highly favorably. Qualitative interviews indicated that the toolkit was viewed as a feasible therapeutic tool that positively impacted clinician motivation to use exposure. Primary challenges related to exposure use more generally, and included client and service setting barriers. Results suggested initial toolkit acceptability and feasibility. Future work to refine the toolkit and test its efficacy as an implementation strategy to increase clinician use of exposure therapy is warranted. Next steps include development of additional content in partnership with key stakeholders, and testing the toolkit's impact on increasing clinician use of exposure therapy.
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Affiliation(s)
- Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 floor, Philadelphia, PA 19104, USA, 215-573-5614.,Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, 19104
| | - Martin Franklin
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 floor, Philadelphia, PA 19104, USA, 215-573-5614
| | - Jessica Bodie
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 floor, Philadelphia, PA 19104, USA, 215-573-5614.,Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, 19104
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 floor, Philadelphia, PA 19104, USA, 215-573-5614
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18
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Initial Clinician Reports of the Bottom-Up Dissemination of an Evidence-Based Intervention for Early Childhood Trauma. CHILD & YOUTH CARE FORUM 2017. [DOI: 10.1007/s10566-017-9422-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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19
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Becker-Haimes EM, Okamura K, Wolk CB, Rubin R, Evans AC, Beidas RS. Predictors of clinician use of exposure therapy in community mental health settings. J Anxiety Disord 2017; 49:88-94. [PMID: 28475946 PMCID: PMC5501186 DOI: 10.1016/j.janxdis.2017.04.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/26/2017] [Indexed: 12/21/2022]
Abstract
Exposure therapy is recognized as the key component of cognitive-behavioral treatment for anxiety. However, exposure is the least used evidence-based treatment in community mental health settings and is the most challenging technique for clinicians to adopt within the context of effectiveness and implementation trials. Little work has examined clinician and organizational characteristics that predict use of exposure, which is important for identifying implementation strategies that may increase its use. In a large sample of community health clinicians (N=335) across 31 clinical practice sites, this study characterized clinician and organizational predictors of exposure use and relaxation for anxiety. Mixed effects regression analyses indicated that both clinician attitudes and an organization's implementation climate may be important levers for interventions seeking to increase clinician exposure use. Greater clinician use of relaxation strategies was also associated with less exposure use. Results point to important implications for implementing cognitive-behavioral therapy for anxiety, including de-emphasizing relaxation and attending to organizational climate.
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Affiliation(s)
- Emily M. Becker-Haimes
- University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 floor, Philadelphia, PA 19104, USA, 215-746-1759,Corresponding author, Rinad S. Beidas, , phone: 215-746-1759, fax: 215-349-8715 3535 Market Street, 3rd Floor Philadelphia, PA 19104
| | - Kelsie Okamura
- University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 floor, Philadelphia, PA 19104, USA, 215-746-1759
| | - Courtney Benjamin Wolk
- University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104, USA.
| | - Ronnie Rubin
- Department of Behavioral Health and Intellectual Disability Services, 1101 Market St. Philadelphia, PA 19107, USA.
| | - Arthur C. Evans
- Department of Behavioral Health and Intellectual disAbility Services, 1101 Market St. Philadelphia, PA 19107
| | - Rinad S. Beidas
- University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 floor, Philadelphia, PA 19104, USA, 215-746-1759
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20
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Bennett-Levy J, Singer J, DuBois S, Hyde K. Translating E-Mental Health Into Practice: What Are the Barriers and Enablers to E-Mental Health Implementation by Aboriginal and Torres Strait Islander Health Professionals? J Med Internet Res 2017; 19:e1. [PMID: 28077347 PMCID: PMC5266824 DOI: 10.2196/jmir.6269] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 12/01/2016] [Accepted: 12/18/2016] [Indexed: 01/10/2023] Open
Abstract
Background With increasing evidence for the effectiveness of e-mental health interventions for enhancing mental health and well-being, a growing challenge is how to translate promising research findings into service delivery contexts. A 2012 e-mental health initiative by the Australian Federal Government (eMHPrac) has sought to address the issue through several strategies, one of which has been to train different health professional workforces in e-mental health (e-MH). Objective The aim of the study was to report on the barriers and enablers of e-MH uptake in a cohort of predominantly Aboriginal and Torres Strait Islander health professionals (21 Indigenous, 5 non-Indigenous) who occupied mainly support or case management roles within their organizations. Methods A 3- or 2-day e-MH training program was followed by up to 5 consultation sessions (mean 2.4 sessions) provided by the 2 trainers. The trainer-consultants provided written reports on each of the 30 consultation sessions for 7 consultation groups. They were also interviewed as part of the study. The written reports and interview data were thematically analyzed by 2 members of the research team. Results Uptake of e-MH among the consultation group was moderate (22%-30% of participants). There were significant organizational barriers to uptake resulting from procedural and administrative problems, demanding workloads, prohibitive policies, and a lack of fit between the organizational culture and the introduction of new technologies. Personal barriers included participant beliefs about the applicability of e-MH to certain populations, and workers’ lack of confidence and skills. However, enthusiastic managers and tech-savvy champions could provide a counter-balance as organizational enablers of e-MH; and the consultation sessions themselves appear to have enhanced skills and confidence, shifted attitudes to new technologies, and seeded a perception that e-MH could be a valuable health education resource. Conclusions A conclusion from the program was that it was important to match e-MH training and resources to work roles. In the latter stages of the consultation sessions, the Aboriginal and Torres Strait Islander health professionals responded very positively to YouTube video clips and apps with a health education dimension. Therapy-oriented apps and programs may fit less well within the scope of practice of some workforces, including this one. We suggest that researchers broaden their focus and definitions of e-MH and give rather more weight to e-MH’s health education possibilities. Developing criteria for evaluating apps and YouTube videos may empower a rather greater section of health workforce to use e-MH with their clients.
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Affiliation(s)
- James Bennett-Levy
- University Centre for Rural Health, University of Sydney, Lismore, Australia
| | - Judy Singer
- University Centre for Rural Health, University of Sydney, Lismore, Australia
| | - Simon DuBois
- University Centre for Rural Health, University of Sydney, Lismore, Australia
| | - Kelly Hyde
- University Centre for Rural Health, University of Sydney, Lismore, Australia
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21
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Beidas RS, Adams DR, Kratz HE, Jackson K, Berkowitz S, Zinny A, Cliggitt LP, DeWitt KL, Skriner L, Evans A. Lessons learned while building a trauma-informed public behavioral health system in the City of Philadelphia. EVALUATION AND PROGRAM PLANNING 2016; 59:21-32. [PMID: 27501466 PMCID: PMC5048572 DOI: 10.1016/j.evalprogplan.2016.07.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 07/14/2016] [Indexed: 05/20/2023]
Abstract
Exposure to traumatic experiences among youth is a serious public health concern. A trauma-informed public behavioral health system that emphasizes core principles such as understanding trauma, promoting safety, supporting consumer autonomy, sharing power, and ensuring cultural competence, is needed to support traumatized youth and the providers who work with them. This article describes a case study of the creation and evaluation of a trauma-informed publicly funded behavioral health system for children and adolescents in the City of Philadelphia (the Philadelphia Alliance for Child Trauma Services; PACTS) using the Exploration, Preparation, Implementation, and Sustainment (EPIS) as a guiding framework. We describe our evaluation of this effort with an emphasis on implementation determinants and outcomes. Implementation determinants include inner context factors, specifically therapist knowledge and attitudes (N=114) towards evidence-based practices. Implementation outcomes include rate of PTSD diagnoses in agencies over time, number of youth receiving TF-CBT over time, and penetration (i.e., number of youth receiving TF-CBT divided by the number of youth screening positive on trauma screening). We describe lessons learned from our experiences building a trauma-informed public behavioral health system in the hopes that this case study can guide other similar efforts.
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Affiliation(s)
- Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA.
| | - Danielle R Adams
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA
| | - Hilary E Kratz
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA
| | - Kamilah Jackson
- Community Behavioral Health, 801 Market Street, Philadelphia, PA 19107, USA, USA
| | - Steven Berkowitz
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA
| | - Arturo Zinny
- Community Behavioral Health, 801 Market Street, Philadelphia, PA 19107, USA, USA
| | - Lauren Pilar Cliggitt
- Hall Mercer, Community Mental Health Center, 245 South 8th Street, Philadelphia, PA 19106, USA
| | - Kathryn L DeWitt
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA
| | - Laura Skriner
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA
| | - Arthur Evans
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA; Department of Behavioral Health and Intellectual disAbility Services, 1101 Market Street, Philadelphia, PA 19107, USA
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22
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Wiltsey Stirman S, Gutner CA, Crits-Christoph P, Edmunds J, Evans AC, Beidas RS. Relationships between clinician-level attributes and fidelity-consistent and fidelity-inconsistent modifications to an evidence-based psychotherapy. Implement Sci 2015; 10:115. [PMID: 26268633 PMCID: PMC4534152 DOI: 10.1186/s13012-015-0308-z] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinicians often modify evidence-based psychotherapies (EBPs) when delivering them in routine care settings. There has been little study of factors associated with or implications of modifications to EBP protocols. This paper differentiates between fidelity-consistent and fidelity-inconsistent modifications and it examines the potential influence of two clinician characteristics, training outcomes, and attitudes toward EBPs on fidelity-consistent and fidelity-inconsistent modifications of cognitive behavioral therapy in a sample of clinicians who had been trained to deliver these treatments for children or adults. METHODS Survey and coded interview data collected 2 years after completion of training programs in cognitive behavioral therapy were used to examine associations between successful or unsuccessful completion of training, clinician attitudes, and modifications. Modifications endorsed by clinicians were categorized as fidelity-consistent or fidelity-inconsistent and entered as outcomes into separate regression models, with training success and attitudes entered as independent variables. RESULTS Successful completion of a training program was associated with subsequent fidelity-inconsistent modifications but not fidelity-consistent modifications. Therapists who reported greater openness to using EBPs prior to training reported more fidelity-consistent modifications at follow-up, and those who reported greater willingness to adopt EBPs if they found them appealing were more likely to make fidelity-inconsistent modifications. CONCLUSIONS Implications of these findings for training, implementation, EBP sustainment, and future studies are discussed. Research on contextual and protocol-related factors that may impact decisions to modify EBPs will be an important future direction of study to complement to this research.
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Affiliation(s)
- Shannon Wiltsey Stirman
- National Center for PTSD, VA Boston Healthcare System, and Boston University School of Medicine, Department of Psychiatry, 150 S. Huntington Ave (116B3), Boston, MA, 02130, USA.
| | - Cassidy A Gutner
- National Center for PTSD, VA Boston Healthcare System, and Boston University School of Medicine, Department of Psychiatry, 150 S. Huntington Ave (116B3), Boston, MA, 02130, USA.
| | - Paul Crits-Christoph
- Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, Philadelphia, USA.
| | - Julie Edmunds
- Department of Psychiatry, Harvard University Medical School, Boston, MA, USA.
| | - Arthur C Evans
- Philadelphia Department of Behavioral Health and Developmental disAbility Services, 3535 Market Street, Philadelphia, USA.
| | - Rinad S Beidas
- Center for Mental Health Policy and Services Research, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, USA.
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