1
|
Rojas-Andrade R, Aranguren Zurita S, Prosser Bravo G, Vargas B. Intrinsic Motivation and Institutional Limitations: Key Implementation Determinants of Psychological First Aid Training. Community Ment Health J 2024; 60:1094-1103. [PMID: 38489127 DOI: 10.1007/s10597-024-01261-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 02/25/2024] [Indexed: 03/17/2024]
Abstract
Psychological first aid (PFA) trainings are conducted to train frontline care workers in practical and emotional support to people who have been recently affected by stressful events. The aim of this study was to describe the determinants of the implementation behavior of a PFA training strategy in Chile and to provide theoretical information on the factors that influence trainers' self-efficacy. For this purpose, the Determinants of Implementation Behavior Questionnaire, administered online to a sample of 117 PFA trainers throughout Chile, was used. The results indicate that the main facilitators for implementation originate in the intrinsic motivation of the trainers, while the barriers are mainly found in the limited institutional opportunities offered by the context. Evidence was also found on the effect of motivation and context on trainer self-efficacy. PFA trainers may need to invest a lot of psychological resources to overcome the barriers encountered during implementation.
Collapse
Affiliation(s)
- Rodrigo Rojas-Andrade
- Escuela de Psicología, Universidad Santiago de Chile, Ecuador 3650, Estación Central, Santiago, Región Metropolitana, Chile.
| | | | | | - Belén Vargas
- Universidad de Chile, Núcleo Milenio para Mejorar la Salud Mental de Adolescentes y Jóvenes, Ministerio de Salud, Santiago, Imhay, Santiago, Chile
| |
Collapse
|
2
|
Ponzano M, Tibert N, Brien S, Funnell L, Gibbs JC, Keller H, Laprade J, Morin SN, Papaioannou A, Weston ZJ, Wideman TH, Giangregorio LM. Development, Acceptability, and Usability of a Virtual Intervention for Vertebral Fractures. Phys Ther 2023; 103:pzad098. [PMID: 37555708 DOI: 10.1093/ptj/pzad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE This project aimed to develop a virtual intervention for vertebral fractures (VIVA) to implement the international recommendations for the nonpharmacological management of osteoporotic vertebral fractures and to test its acceptability and usability. METHODS VIVA was developed in accordance with integrated knowledge translation principles and was informed by the Behavioral Change Wheel, the Theoretical Domains Framework, and the affordability, practicability, effectiveness and cost-effectiveness, acceptability, side effects/safety, and equity (APEASE) criteria. The development of the prototype of VIVA involved 3 steps: understanding target behaviors, identifying intervention options, and identifying content and implementation options. The VIVA prototype was delivered to 9 participants to assess its acceptability and usability. RESULTS VIVA includes 7 1-on-1 virtual sessions delivered by a physical therapist over 5 weeks. Each session lasts 45 minutes and is divided in 3 parts: education, training, and behavioral support/goal setting. Four main themes emerged from the acceptability evaluation: perceived improvements in pain, increased self-confidence, satisfaction with 1-on-1 sessions and resources, and ease of use. All of the participants believed that VIVA was very useful and were very satisfied with the 1-on-1 sessions. Four participants found the information received very easy to practice, 4 found it easy to practice, and 1 found it somewhat difficult to practice. Five participants were satisfied with the supporting resources, and 4 were very satisfied. Potential for statistically significant improvements was observed in participants' ability to make concrete plans about when, how, where, and how often to exercise. CONCLUSION VIVA was acceptable and usable to the participants, who perceived improvements in pain and self-confidence. IMPACT The virtual implementation of the recommendations for the nonpharmacological management of vertebral fractures showed high acceptability and usability. Future trials will implement the recommendations on a larger scale to evaluate their effectiveness.
Collapse
Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, University of British Columbia, Kelowna BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicholas Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sheila Brien
- Canadian Osteoporosis Patient Network, Osteoporosis, Toronto, ON, Canada
| | - Larry Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis, Toronto, ON, Canada
| | - Jenna C Gibbs
- Department of Kinesiology and Physical Activity, McGill University, Montreal, QC, Canada
| | - Heather Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Judi Laprade
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Zachary J Weston
- Canadian Society for Exercise Physiology (CSEP), Ottawa Ontario, Canada
- Faculty of Human and Social Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Timothy H Wideman
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Lora M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| |
Collapse
|
3
|
Powers KE, das Nair R, Phillips J, Farrin A, Radford KA. Exploring the Association between Individual-Level Attributes and Fidelity to a Vocational Rehabilitation Intervention within a Randomised Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4694. [PMID: 36981601 PMCID: PMC10048688 DOI: 10.3390/ijerph20064694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Understanding what attributes or characteristics of those delivering interventions affect intervention fidelity and patient outcomes is important for contextualising intervention effectiveness. It may also inform implementation of interventions in future research and clinical practice. This study aimed to explore the relationships between attributes of Occupational Therapists (OTs), their faithful delivery of an early stroke specialist vocational rehabilitation intervention (ESSVR), and stroke survivor return-to-work (RTW) outcomes. Thirty-nine OTs were surveyed about their experience and knowledge of stroke and vocational rehabilitation and were trained to deliver ESSVR. ESSVR was delivered across 16 sites in England and Wales between February 2018 and November 2021. OTs received monthly mentoring to support ESSVR delivery. The amount of mentoring each OT received was recorded in OT mentoring records. Fidelity was assessed using an intervention component checklist completed using retrospective case review of one randomly selected participant per OT. Linear and logistic regression analyses explored relationships between OT attributes, fidelity, and stroke survivor RTW outcome. Fidelity scores ranged from 30.8 to 100% (Mean: 78.8%, SD: 19.2%). Only OT engagement in mentoring was significantly associated with fidelity (b = 0.29, 95% CI = 0.05-0.53, p < 0.05). Increased fidelity (OR = 1.06, 95% CI = 1.01-1.1, p = 0.01) and increasing years of stroke rehabilitation experience (OR = 1.17, 95% CI = 1.02-1.35) was significantly associated with positive stroke survivor RTW outcomes. Findings of this study suggest that mentoring OTs may increase fidelity of delivery of ESSVR, which may also be associated with positive stroke survivor return-to-work outcomes. The results also suggest that OTs with more experience of stroke rehabilitation may be able to support stroke survivors to RTW more effectively. Upskilling OTs to deliver complex interventions, such as ESSVR, in clinical trials may require mentoring support in addition to training to ensure fidelity.
Collapse
Affiliation(s)
- Katie E. Powers
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Roshan das Nair
- Health Division, SINTEF, 7465 Trondheim, Norway
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Julie Phillips
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9JT, UK
| | - Kathryn A. Radford
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| |
Collapse
|
4
|
Cloutier-Bergeron A, Samson A, Provencher V, Mongeau L, Paquette MC, Turcotte M, Bégin C. Health At Every Size intervention® under real-world conditions: the rights and wrongs of program implementation. Health Psychol Behav Med 2022; 10:935-955. [PMID: 36210868 PMCID: PMC9543046 DOI: 10.1080/21642850.2022.2128357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Implementation integrity is known to be critical to the success of interventions. The Health At Every Size® (HAES®) approach is deemed to be a sustainable intervention on weight-related issues. However, no study in the field has yet investigated the effects of implementation on outcomes in a real-world setting.
Collapse
Affiliation(s)
| | - Amélie Samson
- Centre de recherche Nutrition, santé et société (NUTRISS), INAF, Université Laval, Québec, Canada
- Ministère de la santé et des services sociaux, Québec, Canada
| | - Véronique Provencher
- Centre de recherche Nutrition, santé et société (NUTRISS), INAF, Université Laval, Québec, Canada
- School of Nutrition, Université Laval, Québec, Canada
| | - Lyne Mongeau
- School of Public Health, Université de Montréal, Montréal, Canada
| | - Marie-Claude Paquette
- Institut national de santé publique du Québec, Québec, Canada
- Department of Nutrition, Université de Montréal, Montréal, Canada
| | - Mylène Turcotte
- Centre de recherche Nutrition, santé et société (NUTRISS), INAF, Université Laval, Québec, Canada
| | - Catherine Bégin
- School of Psychology, Université Laval, Québec, Canada
- Centre de recherche Nutrition, santé et société (NUTRISS), INAF, Université Laval, Québec, Canada
| |
Collapse
|
5
|
Giusto A, Friis-Healy EA, Kaiser BN, Ayuku D, Rono W, Puffer ES. Mechanisms of change for a family intervention in Kenya: An Integrated Clinical and Implementation Mapping approach. Behav Res Ther 2022; 159:104219. [PMID: 36283239 PMCID: PMC10155602 DOI: 10.1016/j.brat.2022.104219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/02/2022] [Accepted: 10/14/2022] [Indexed: 12/14/2022]
Abstract
To increase cultural relevance and maximize access for historically underserved populations, there is a need to explore mechanisms underlying treatment outcomes during piloting. We developed a mixed-method approach, Integrated Clinical and Implementation Mapping (ICIM), to explore clinical and implementation mechanisms to inform improvements in content and delivery. We applied ICIM in a pilot of Tuko Pamoja, a lay counselor-delivered family intervention in Kenya (10 families with adolescents ages 12-17). ICIM is a 3-phase process to triangulate data sources to analyze how and why change occurs within individual cases and across cases. We synthesized data from session and supervision transcripts, fidelity and clinical skills ratings, surveys, and interviews. Outputs included a comprehensive narrative and visual map depicting how content and implementation factors influenced change. For Tuko Pamoja, ICIM results showed common presenting problems, including financial strain and caregivers' distress, triggering negative interactions and adolescent distress. ICIM demonstrated that active treatment ingredients included communication skills and facilitated, prescribed time together. Families improved communication, empathy, and hope, facilitated improved family functioning and mental health. Key implementation mechanisms included provider clinical competencies, alliance-building, treatment-aligned adaptations, and consistent attendance. Results guided manual and training refinements and generated hypotheses about mechanisms to test in larger trials.
Collapse
Affiliation(s)
- Ali Giusto
- New York State Psychiatric Institute, Columbia University, Department of Psychiatry, New York, NY, 10032, USA; Duke Global Health Institute, Durham, NC, USA.
| | - Elsa A Friis-Healy
- Duke Global Health Institute, Durham, NC, USA; Department of Psychiatry Duke University School of Medicine, Durham, NC, USA.
| | - Bonnie N Kaiser
- Duke Global Health Institute, Durham, NC, USA; University of California San Diego, Anthropology Department and Global Health Program, La Jolla, CA, USA.
| | - David Ayuku
- Moi University, Academic Highway, Eldoret, Usain Gishu County, Kenya.
| | - Wilter Rono
- Moi Teaching & Referral Hospital, Eldoret, Rift Valley, Kenya.
| | - Eve S Puffer
- Duke Global Health Institute, Durham, NC, USA; Department of Neuroscience and Psychology, Duke University, Durham, NC, USA.
| |
Collapse
|
6
|
Nielsen SS, Skou ST, Larsen AE, Polianskis R, Pawlak WZ, Vægter HB, Søndergaard J, Christensen JR. Occupational therapy lifestyle intervention added to multidisciplinary treatment for adults living with chronic pain: a feasibility study. BMJ Open 2022; 12:e060920. [PMID: 36115674 PMCID: PMC9486323 DOI: 10.1136/bmjopen-2022-060920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility and outcomes of an occupational therapy lifestyle intervention for adults living with chronic pain. DESIGN This one-group pre-post interventional study investigated the feasibility and outcomes of the Redesign Your Everyday Activities and Lifestyle with Occupational Therapy (REVEAL(OT)) intervention targeting meaningful activities and lifestyle. SETTINGS The occupational therapist-led intervention was added to standard multidisciplinary chronic pain treatment at a Danish pain centre. PARTICIPANTS Of the 40 adult participants aged 18-64 (mean 46.6±10.9 years old, 85% females, chronic pain duration ≥3 months), there were 31 completers. INTERVENTION Three feasibility rounds were carried out in 2019-2021. The intervention focused on meaningful activities, healthy eating habits and daily physical activity. Methods of didactical presentations, group discussions, personal reflection and experiential learning were used in the intervention composed both of individual and group sessions. OUTCOMES Primary outcomes were predefined research progression criteria evaluated by the red-amber-green method. Secondary outcomes measured pre-post changes in health-related quality of life and occupational performance and satisfaction. RESULTS The study demonstrated satisfactory programme adherence (77.5%), patients' self-perceived relevance (97%), timing and mode of delivery (97%) and assessment procedure acceptance (95%). No adverse events causing discontinuation occurred. Recruitment rate (n=5.7 monthly), retention (77.5%) and the fidelity of delivery (83.3%) needed improvement. We observed no improvement in health-related quality of life (mean=0.04, 95% CI -0.03 to 0.12) but positive change in occupational performance (mean=1.80, 95% CI 1.25 to 2.35) and satisfaction (mean=1.95, 95% CI 1.06 to 2.84). The participants reached the minimal clinically important difference for occupational performance (≥3.0 points in 13.8%) and satisfaction (≥3.2 points in 24.0%). CONCLUSIONS The REVEAL(OT) intervention was feasible to deliver and beneficial for the participants' occupational performance and satisfaction. The interventions' recruitment, retention and delivery strategies need optimisation in a future definitive trial. TRIAL REGISTRATION NUMBER NCT03903900.
Collapse
Affiliation(s)
- Svetlana Solgaard Nielsen
- User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Søren T Skou
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anette Enemark Larsen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, University College Copenhagen, Copenhagen, Denmark
| | | | | | - Henrik Bjarke Vægter
- Pain Research Group, Pain Centre South, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Odense, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jeanette Reffstrup Christensen
- User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
7
|
Louie E, Giannopoulos V, Baillie A, Uribe G, Wood K, Teesson M, Haber PS, Morley KC. Relationship between clinician-level attributes and implementation outcomes from the Pathways to Comorbidity Care training program. BMC MEDICAL EDUCATION 2022; 22:605. [PMID: 35931994 PMCID: PMC9354347 DOI: 10.1186/s12909-022-03671-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The process of determining the best strategy for increasing the uptake of evidence-based practice might be improved through an understanding of relevant clinician-level factors. The Pathways to Comorbidity Care (PCC) training program (Louie E, et al., J Dual Diagnosis 17:304-12, 2021) aimed to facilitate integrated management of comorbid drug and alcohol and mental disorders amongst drug and alcohol clinicians. We hypothesised that uptake of integrated management of comorbidity following the implementation of the PCC program would be associated with clinician-level: (i) demographics (gender, education, experience), (ii) attitudes (evidence-based practice, therapist manuals, counselling self-efficacy), and (iii) organisational readiness to change. METHODS Twenty clinicians participated in the 9-month PCC training program. Attitudes towards evidence-based practices and psychotherapist manuals, self-efficacy, and organisational readiness to change, along with demographics, were measured at baseline. At follow-up, change in Comorbidity Practice (CoP) scores related to integrated comorbidity management were obtained using a file audit checklist and categorised into high (at least 60% increase in CoP), medium or low (a decrease of - 20% or less in CoP). Clinician-level characteristics were examined across the implementation categories. RESULTS There were no significant differences found between implementation groups on sociodemographic variables (p's > 0.30), attitudes to evidence-based practices, attitudes to therapist manuals, and self-efficacy (p's > 0.52). The high implementation group demonstrated significantly higher scores on leadership practices aspect of organisational readiness to change relative to the low and medium implementation group ((F(2, 16) = 3.63, p = 0.05; Cohen's d = .31) but not on the other subscales (p's > 0.07). CONCLUSIONS Confidence that leadership will play a positive role in the implementation process may improve effectiveness of comorbidity training programs for drug and alcohol clinicians. On the other hand, contrary to our hypothesis, counselling self-efficacy, evidence-based practice attitudes, attitudes towards therapist manuals, gender, education and experience were not distinguishing factors.
Collapse
Affiliation(s)
- Eva Louie
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Edith Collins Centre (Translational Centre in Alcohol, Drugs & Toxicology), Sydney Local Health District & Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Vicki Giannopoulos
- Edith Collins Centre (Translational Centre in Alcohol, Drugs & Toxicology), Sydney Local Health District & Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Andrew Baillie
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Gabriela Uribe
- Menzies Centre for Health Policy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Katie Wood
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, NSW, Australia
| | - Paul S Haber
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Edith Collins Centre (Translational Centre in Alcohol, Drugs & Toxicology), Sydney Local Health District & Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kirsten C Morley
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
- Edith Collins Centre (Translational Centre in Alcohol, Drugs & Toxicology), Sydney Local Health District & Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- Addiction Medicine, Central Clinical School, Sydney Medical School, University of Sydney, Camperdown, NSW, 2006, Australia.
| |
Collapse
|
8
|
Balán IC, Lentz C, Giguere R, Dolezal C, Kajura-Manyindo C, Kutner BA, Zalwango A, Makoni R, Madlala B, Makala Y, Khanyile N, Kadyamusuma M, Kachenjera L, Ndhlovu-Forde Z, Tuswa-Haynes N. Inconsistent Counselor Fidelity in Delivering an Evidence-Based Adherence Intervention During a PrEP Trial. AIDS Behav 2022; 26:698-708. [PMID: 34390433 PMCID: PMC8840968 DOI: 10.1007/s10461-021-03429-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Evidence-based adherence counseling interventions must be delivered with fidelity to ensure that their effectiveness is retained, but little is known regarding how counselors in biomedical HIV trials deliver these interventions. Forty-two counselors from the MTN-025/HOPE Study, which was conducted in 14 sites in sub-Saharan Africa, participated. They completed a quantitative assessment and consented for their HOPE counseling session ratings to be analyzed. Twenty-two (52%) self-identified as research nurses and 20 (48%) as counselors. Of 928 session ratings, 609 (66%) were classified as Good, 188 (20%) as Fair, and 131 (14%) as Poor, based on pre-established criteria. Overall mean ratings for session tasks and global components (each rated from 1 to 5) were 4.12 (SD = 0.45; range 2.46-4.73) and 4.02 (SD = 0.64; range 1.75-4.79), respectively. Twenty-six (62%) counselors attained Good or Fair ratings on at least 85% of their sessions, but 33% of counselors had more than 25% of their sessions rated as Poor; three counselors (7%) never met criteria for a Good session. Even after extensive training, counselors' fidelity to the intervention varied. Our findings highlight the value of fidelity monitoring using session audio-recordings, the importance of ongoing coaching and support, and the need to plan for counselors with consistently poor fidelity.
Collapse
Affiliation(s)
- Iván C Balán
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
- Florida State University College of Medicine, Tallahassee, FL, USA.
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Clare Kajura-Manyindo
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Bryan A Kutner
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Aisha Zalwango
- Makerere University - Johns Hopkins University Research Collaboration CRS, Kampala, Uganda
| | - Rujeko Makoni
- University of Zimbabwe College of Health Sciences Zengeza Clinical Trials Unit, Harare, Zimbabwe
| | - Bernadette Madlala
- CAPRISA Clinical Trials Unit for AIDS/Tuberculosis Prevention and Treatment, Durban, South Africa
| | - Yvonne Makala
- University of North Carolina Lilongwe Clinical Research Site, Lilongwe, Malawi
| | - Nombuso Khanyile
- South African Medical Research Council Tongaat Clinical Trials Unit, Durban, South Africa
| | - McLoddy Kadyamusuma
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Lonely Kachenjera
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Zanele Ndhlovu-Forde
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - NoCamagu Tuswa-Haynes
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| |
Collapse
|
9
|
Speers AJ, Bhullar N, Cosh S, Wootton BM. Correlates of therapist drift in psychological practice: A systematic review of therapist characteristics. Clin Psychol Rev 2022; 93:102132. [DOI: 10.1016/j.cpr.2022.102132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 07/10/2021] [Accepted: 02/13/2022] [Indexed: 11/03/2022]
|
10
|
McGuier EA, Rothenberger SD, Friedman A, Kolko DJ. An equivalence analysis of provider education in youth mental health care. Health Serv Res 2021; 56:440-452. [PMID: 33844276 PMCID: PMC8143690 DOI: 10.1111/1475-6773.13659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To test for equivalence between providers with and without advanced degrees in multiple domains related to delivery of evidence-based treatment. DATA SOURCE Provider and client data from an effectiveness trial of Alternatives for Families: A Cognitive Behavioral Therapy (AF-CBT) in a major metropolitan area in the United States. STUDY DESIGN We tested for equivalence between providers (N = 182) with and without advanced degrees in treatment-related knowledge, practices, and attitudes; job demands and stress; and training engagement and trainer-rated competence in AF-CBT. We also conducted exploratory analyses to test for equivalence in family clinical outcomes. DATA COLLECTION Providers completed measures prior to randomization and at 6-month follow-up, after completion of training and consultation in AF-CBT. Children and caregivers completed assessments at 0, 6, 12, and 18 months. PRINCIPAL FINDINGS Providers without advanced degrees were largely non-inferior to those with advanced degrees in treatment-related knowledge, practices, and attitudes, while findings for job demands and stress were mixed. Providers without advanced degrees were non-inferior to providers with advanced degrees in consultation attendance (B = -1.42; confidence interval (CI) = -3.01-0.16; margin of equivalence (Δ) = 2), number of case presentations (B = 0.64; CI = -0.49-1.76; Δ = 2), total training hours (B = -4.57; CI = -10.52-1.37; Δ = 3), and trainer-rated competence in AF-CBT (B = -0.04; CI = -3.04-2.96; Δ = 4), and they were significantly more likely to complete training (odds ratio = 0.66; CI = 0.10-0.96; Δ = 30%). Results for clinical outcomes were largely inconclusive. CONCLUSIONS Provider-level outcomes for those with and without advanced degrees were generally comparable. Additional research is needed to examine equivalence in clinical outcomes. Expanding evidence-based treatment training to individuals without advanced degrees may help to reduce workforce shortages and improve reach of evidence-based treatments.
Collapse
Affiliation(s)
- Elizabeth A. McGuier
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Scott D. Rothenberger
- Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Abbey Friedman
- Western Psychiatric HospitalUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - David J. Kolko
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- Western Psychiatric HospitalUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| |
Collapse
|
11
|
Giannopoulos V, Morley KC, Uribe GM, Louie E, Wood K, Teesson M, Baillie A, Haber PS. The role of clinical supervision in implementing evidence-based practice for managing comorbidity. CLINICAL SUPERVISOR 2021. [DOI: 10.1080/07325223.2021.1909517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Vicki Giannopoulos
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Kirsten C. Morley
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gabriela M. Uribe
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Eva Louie
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katie Wood
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Maree Teesson
- Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Andrew Baillie
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Paul S. Haber
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
12
|
Boeckmann M, Dogar O, Saeed S, Majidulla A, Swami S, Khan A, Siddiqi K, Kotz D. Measuring fidelity to delivery of a new smoking cessation intervention integrated into routine tuberculosis care in Pakistan and Bangladesh: Contextual differences and opportunities. Tob Induc Dis 2021; 19:24. [PMID: 33841063 PMCID: PMC8029647 DOI: 10.18332/tid/133054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/10/2021] [Accepted: 02/04/2021] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Tobacco smoking among tuberculosis (TB) patients leads to poorer treatment outcomes. Smoking cessation support should be integrated into routine TB care. We measured healthcare providers' fidelity to a smoking cessation intervention integrated into routine TB care, in Bangladesh and Pakistan. We aimed to understand the role of providers and settings in the implementation of behavior support (BS) messages for TB and smoking cessation. METHODS The integrated BS intervention was implemented in TB clinics (24 public and 1 private). Cross-sectional data were collected on the fidelity of delivery of the BS intervention using a predefined fidelity index based on an existing validated method of measuring intervention fidelity. Audio-recordings of patient-provider BS sessions were coded using the fidelity index. Intervention fidelity was presented as the proportion of sessions that implemented BS messages. RESULTS A total of 96 sessions were conducted, 37 in Bangladesh and 59 in Pakistan. In public settings, TB medication advice was offered in 91.9% (95% CI: 78.7- 97.2) of sessions in Bangladesh, and in 75.5% (95% CI: 62.4-85.1) of sessions in Pakistan; whilst it was offered in 83.3% (95% CI: 43.7-97.0) of sessions in the private setting in Pakistan. Patients' smoking status was assessed in 70.3% (95% CI: 54.2-82.5) of sessions in Bangladesh, and in 34.0% (95% CI: 22.7-47.4) of sessions in the public setting and in 66.7% (95% CI: 30.0-90.3) of sessions in the private setting in Pakistan. A quit date was set in 32.4% (95% CI: 19.6-48.5) of all sessions in Bangladesh, and in 33.3% (95% CI: 9.6-70.0) of all sessions in the public setting in Pakistan. CONCLUSIONS Fidelity to the intended delivery of the intervention was found to be high for TB-related messages but not for smoking cessation messages. Clinic contexts may play a mediating role in health workers' opportunities to deliver the intervention as planned. TRIAL REGISTRATION International Standard Randomized Clinical Trial Number (ISRCTN43811467). Registered 23 March 2016, https://doi.org/10.1186/ISRCTN43811467.
Collapse
Affiliation(s)
- Melanie Boeckmann
- School of Public Health, Bielefeld University, Bielefeld, Germany
- Department of Health Sciences, University of York, York, United Kingdom
- Addiction Research and Clinical Epidemiology Unit, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Omara Dogar
- Department of Health Sciences, University of York, York, United Kingdom
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Shilpi Swami
- Department of Health Sciences, University of York, York, United Kingdom
- Evidera, London, United Kingdom
| | | | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
| | - Daniel Kotz
- Addiction Research and Clinical Epidemiology Unit, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
13
|
Dickson KS, Suhrheinrich J. Concordance between Community Supervisor and Provider Ratings of Fidelity: Examination of Multi-Level Predictors and Outcomes. JOURNAL OF CHILD AND FAMILY STUDIES 2021; 30:542-555. [PMID: 34149272 PMCID: PMC8211028 DOI: 10.1007/s10826-020-01877-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 06/12/2023]
Abstract
Fidelity is conceptualized as a key mechanism impacting treatment outcomes, yet community examination of fidelity is limited, partly due to limited feasible training methods and tools. Provider-report tools represent a feasible method for improving routine fidelity monitoring. Additional work examining the effectiveness of these methods and concordance with other fidelity sources is needed. Further, provider and client factors impact both intervention implementation and concordance, but their impact on fidelity measurement is poorly understood. Using a train-the-trainer methodology, we examine concordance between three methods of assessing fidelity (trained independent coders, supervisor evaluation and provider self-report) using a fidelity assessment tool adapted for community use. Multilevel models examined predictors (provider- and child- level factors) and outcomes (provider average fidelity) of concordance. Results suggest supervisors and providers are able to use the fidelity tool, but demonstrated variable concordance, with higher concordance with trained coders for supervisors than providers. Provider credentials and child language were marginally predictive of rater concordance. Higher supervisor accuracy was associated with higher provider fidelity. Findings inform broader efforts to improve the development and implementation of feasible fidelity tools for routine use in community settings and highlight multi-level factors impacting the adoption and implementation of such tools.
Collapse
Affiliation(s)
- Kelsey S. Dickson
- San Diego State University, 5500 Campanile Drive, San Diego, CA 92182 USA
- Child and Adolescent Services Research Center, 3020 Children’s Way MC5033, San Diego, CA 92123 USA
| | - Jessica Suhrheinrich
- San Diego State University, 5500 Campanile Drive, San Diego, CA 92182 USA
- Child and Adolescent Services Research Center, 3020 Children’s Way MC5033, San Diego, CA 92123 USA
| |
Collapse
|
14
|
Sijercic I, Lane JEM, Gutner CA, Monson CM, Stirman SW. The Association Between Clinician and Perceived Organizational Factors with Early Fidelity to Cognitive Processing Therapy for Posttraumatic Stress Disorder in a Randomized Controlled Implementation Trial. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:8-18. [PMID: 31463667 DOI: 10.1007/s10488-019-00966-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A common metric for determining implementation success is the measurement of clinician adherence to, and competence in, delivering a psychotherapy. The present study examined clinician and organizational factors as predictors of early adherence and competence among 78 clinicians delivering cognitive processing therapy (CPT), an evidence-based psychotherapy (EBP) for posttraumatic stress disorder, in a randomized controlled implementation trial. Results indicated that clinicians' willingness to adopt an EBP if required to do so was significantly associated with early adherence and competence in CPT delivery. Level of clinician education was significantly associated with early competence in delivering CPT. Organizational factors did not predict early adherence or competence. Implications of the findings are discussed.
Collapse
Affiliation(s)
| | | | | | | | - Shannon Wiltsey Stirman
- National Center for PTSD, VA Palo Alto Healthcare System & Stanford University, 795 Willow Road, NC-PTSD 334, Menlo Park, CA, 94025, USA.
| |
Collapse
|
15
|
Provider Readiness and Adaptations of Competency Drivers During Scale-Up of the Family Check-Up. J Prim Prev 2020; 40:51-68. [PMID: 30631998 DOI: 10.1007/s10935-018-00533-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We used provider (n = 112) data that staff at the agency disseminating the Family Check-Up (FCU; REACH Institute) collected to profile provider diversity in community settings and to examine whether provider profiles are related to implementation fidelity. Prior to FCU training, REACH Institute staff administered the FCU Provider Readiness Assessment (PRA), a provider self-report measure that assesses provider characteristics previously linked with provider uptake of evidence-based interventions. We conducted a latent class analysis using PRA subscale scores as latent class indicators. Results supported four profiles: experienced high readiness (ExHR), experienced low readiness (ExLR), moderate experience (ME), and novice. The ExHR class was higher than all other classes on: (1) personality variables (i.e., agreeableness, conscientiousness, openness, extraversion); (2) evidence-based practice attitudes; (3) work-related enthusiasm and engagement; and (4) their own well-being. The ExHR class was also higher than ExLR and ME classes on clinical flexibility. The ME class was lowest of all classes on conscientiousness, supervision, clinical flexibility, work-related enthusiasm and engagement, and well-being. During the FCU certification process, FCU Consultants rated providers' fidelity to the model. Twenty-three of the 112 providers that completed the PRA also participated in certification. We conducted follow-up regression analyses using fidelity data for these 23 providers to explore associations between probability of class membership and fidelity. The likelihood of being in the ExHR class was related to higher FCU fidelity, whereas the likelihood of being in the ExLR class was related to lower fidelity. We discuss how provider readiness assessment data can be used to guide the adaptation of provider selection, training, and consultation in community settings.
Collapse
|
16
|
Caron EB, Drake KL, Stewart CE, Muggeo MA, Ginsburg GS. Intervention Adherence and Self-Efficacy as Predictors of Child Outcomes in School Nurse-Delivered Interventions for Anxiety. J Sch Nurs 2020; 38:249-258. [PMID: 32410495 DOI: 10.1177/1059840520925522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study examined the association between two implementation factors, nurse-reported intervention adherence and self-efficacy, and children's outcomes in school nurse-delivered anxiety interventions. Data were collected in a pilot randomized controlled effectiveness trial with 54 children and 21 school nurses. Nurses implemented either a cognitive behavioral or relaxation-skills-only intervention. Nurse questionnaires assessed implementation factors. Independent evaluators assessed changes in children's anxiety symptoms at postintervention and at 3-month follow-up using clinical improvement and global functioning scales. Regression analyses indicated that greater intervention adherence was associated with greater anxiety symptom improvement at follow-up. Nurse self-efficacy interacted with intervention group, such that nurses with higher self-efficacy who implemented the cognitive behavioral intervention tended to have children show improvement and higher postintervention functioning. The impact of implementation factors on children's outcomes may differ depending on intervention type. Self-efficacy may be important for nurses using relatively complex interventions. Intervention adherence should be supported through training and consultation.
Collapse
Affiliation(s)
- E B Caron
- Department of Psychological Science, Fitchburg State University, MA, USA
| | - Kelly L Drake
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA.,Anxiety Treatment Center of Maryland, Columbia, MD, USA
| | - Catherine E Stewart
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | | | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, West Hartford, CT, USA
| |
Collapse
|
17
|
Balán IC, Lentz C, Giguere R, Mayo AJ, Rael CT, Soto-Torres L, Palanee-Phillips T, Mgodi NM, Hillier S, Baeten JM. Implementation of a fidelity monitoring process to assess delivery of an evidence-based adherence counseling intervention in a multi-site biomedical HIV prevention study. AIDS Care 2020; 32:1082-1091. [PMID: 31899954 DOI: 10.1080/09540121.2019.1709614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pre-Exposure Prophylaxis (PrEP) trials often implement counseling to support product adherence. Counseling fidelity can vary significantly across providers and time. Fidelity monitoring can ensure that counseling is delivered as designed. We describe the process, feasibility, and outcomes of monitoring Options counseling fidelity in an open-label study of the dapivirine vaginal ring MTN-025/HOPE. After initial training, 63 counselors from 14 sites in Sub-Sahara Africa audio-recorded counseling sessions with study participants. Sessions were rated by a New York-based team that included bilingual emigres from the study countries. Completed session rating forms were sent to counselors to provide feedback and counseling difficulties were discussed during monthly calls. Of 1456 study participants, 85.7% consented to at least one session, and 20% to all sessions, being audio-recorded. Among 9926 study visits in which Options was expected to occur, 5366 (54.1%) Options sessions were audio-recorded, of which 1238 (23.1%) were reviewed; 1039 (83.9%) were rated as "good" or "fair." Eleven counselors who failed to consistently deliver the intervention were reassigned to back-up status. This study demonstrates the feasibility and benefits of monitoring counseling fidelity using audio-recordings in a multi-site, multi-language, multi-country PrEP trial. Given the investment necessary to conduct such trials, providing counseling oversight is highly warranted.
Collapse
Affiliation(s)
- Iván C Balán
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | | | - Christine Tagliaferri Rael
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Lydia Soto-Torres
- National Institute of Allergy and Infectious Diseases, Division of AIDS, Rockville, MD, USA
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Nyaradzo M Mgodi
- University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe
| | - Sharon Hillier
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh and Magee-Women's Hospital of UPMC, Pittsburgh, PA, USA
| | - Jared M Baeten
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, USA
| | -
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Browne J, Edwards AN, Penn DL, Meyer-Kalos PS, Gottlieb JD, Julian P, Ludwig K, Mueser KT, Kane JM. Factor structure of therapist fidelity to individual resiliency training in the Recovery After an Initial Schizophrenia Episode Early Treatment Program. Early Interv Psychiatry 2018; 12:1052-1063. [PMID: 27860369 DOI: 10.1111/eip.12409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/28/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Evidence-based approaches and early intervention have improved the long-term prognosis of individuals with schizophrenia. However, little is known about the therapeutic processes involved in individual therapy in first-episode psychosis. A comprehensive psychosocial/psychiatric programme for this population, NAVIGATE, includes an individual therapy component, individual resiliency training (IRT). Fidelity of clinicians' adherence to the IRT protocol has been collected to ensure proper implementation of this manual-based intervention. These data can provide insight into the elements of the therapeutic process in this intervention. MATERIALS AND METHODS To achieve this goal, we first examined the factor structure of the IRT fidelity scale with exploratory factor analysis. Second, we explored the relationships among the IRT fidelity ratings with clinician years of experience and years of education, as well as client's baseline symptom severity and duration of untreated psychosis. RESULTS AND CONCLUSIONS Results supported a 2-factor structure of the IRT fidelity scale. Correlations between clinician years of education and fidelity ratings were statistically significant.
Collapse
Affiliation(s)
- Julia Browne
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alexandra N Edwards
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
| | - Piper S Meyer-Kalos
- Minnesota Center for Chemical and Mental Health, School of Social Work, University of Minnesota, St. Paul, Minnesota
| | - Jennifer D Gottlieb
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychology, & Psychiatry, Boston University, Boston, Massachusetts
| | - Paul Julian
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kelsey Ludwig
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychology, & Psychiatry, Boston University, Boston, Massachusetts
| | - John M Kane
- Division of Psychiatry Research, Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, New York, New York
| |
Collapse
|
20
|
Caron EB, Roben CKP, Yarger HA, Dozier M. Novel Methods for Screening: Contributions from Attachment and Biobehavioral Catch-up. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 19:894-903. [PMID: 29671253 PMCID: PMC6177320 DOI: 10.1007/s11121-018-0894-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Preventative interventions are needed across the lifespan, including for children who have experienced maltreatment. However, interventions' effect sizes are typically smaller in real-world settings than in clinical trials. Identifying providers who are likely to implement interventions with fidelity could promote implementation outcomes through targeted allocation of training resources. This study tested two pre-training screening measures as predictors of provider fidelity to Attachment and Biobehavioral Catch-up (ABC), a preventative intervention for maltreated infants. One measure assessed valuing of attachment/openness, and the other used vignettes to assess initial skill in a key intervention component. In a sample of 42 providers across 197 sessions, both screening measures predicted future ABC fidelity, even when controlling for experience and education. These results support the development of screening measures for other interventions, suggesting approaches that target specific qualities and behaviors are likely to predict implementation fidelity.
Collapse
Affiliation(s)
- E B Caron
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Caroline K P Roben
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA
| | - Heather A Yarger
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA.
| |
Collapse
|
21
|
Olmedilla-Zafra A, Rubio VJ, Ortega E, García-Mas A. Effectiveness of a stress management pilot program aimed at reducing the incidence of sports injuries in young football (soccer) players. Phys Ther Sport 2016; 24:53-59. [PMID: 28017518 DOI: 10.1016/j.ptsp.2016.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/01/2016] [Accepted: 09/05/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Several attempts to reduce the incidence of sport injuries using psychosocial interventions produced fruitful, although inconclusive results. This paper presents the effectiveness and implementation issues of a pilot 3-month stress-management and muscle relaxation program aimed at reducing sport injury incidence. DESIGN Pre-post treatment-non treatment group comparison. PROGRAM ADMINISTRATION The program was administered by a trained psychologist on a once-a-week, 1-h session basis. PARTICIPANTS Seventy-four male soccer players from four National Youth league teams voluntarily participated. Teams were randomly assigned to either treatment/non-treatment group. MEASURES Injury protocol, Self-monitoring cards, Athletes' satisfaction and commitment survey, Coaches' interview. RESULTS Group main effect and Time-Group interaction effect were both statistically significant, F(1,60) = 8.30, p = 0.005, η2p = 0.121, with the average number of injuries larger in the post-treatment phase of non-treatment group (p = 0.005, η2p = 0.077). There was a significant decrease in the average number of injuries for the intervention group before and after implementing the program (p < 0.001, η2p = 0.309). CONCLUSIONS A controlled implementation of a psychosocial program was effective in reducing youth soccer sport injuries, with a high level of satisfaction and commitment from the athletes, as well as high acceptance from the coaches.
Collapse
Affiliation(s)
- Aurelio Olmedilla-Zafra
- Department of Personality, Assessment and Psychological Intervention, University of Murcia, Campus Universitario de Espinardo, 30100 Murcia, Spain.
| | - Victor J Rubio
- Department of Biological and Health Psychology, University Autonoma of Madrid, Campus Cantoblanco, 28049 Madrid, Spain.
| | - Enrique Ortega
- Department of Physical Activity and Sport, University of Murcia, Campus de San Javier, 30720 San Javier, Spain.
| | - Alexandre García-Mas
- Department of Basic Psychology, University of Balearic Islands, Crta. Valldemossa, Km 7.5, 07122 Palma, Spain.
| |
Collapse
|
22
|
Waller G, Turner H. Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track. Behav Res Ther 2015; 77:129-37. [PMID: 26752326 DOI: 10.1016/j.brat.2015.12.005] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/08/2015] [Accepted: 12/13/2015] [Indexed: 12/22/2022]
Abstract
Therapist drift occurs when clinicians fail to deliver the optimum evidence-based treatment despite having the necessary tools, and is an important factor in why those therapies are commonly less effective than they should be in routine clinical practice. The research into this phenomenon has increased substantially over the past five years. This review considers the growing evidence of therapist drift. The reasons that we fail to implement evidence-based psychotherapies are considered, including our personalities, knowledge, emotions, beliefs, behaviours and social milieus. Finally, ideas are offered regarding how therapist drift might be halted, including a cognitive-behavioural approach for therapists that addresses the cognitions, emotions and behaviours that drive and maintain our avoidance of evidence-based treatments.
Collapse
Affiliation(s)
- Glenn Waller
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Western Bank, Sheffield, S10 2NT, UK.
| | - Hannah Turner
- Southern Health Eating Disorders Service, Southern Health NHS Foundation Trust, Southampton, UK
| |
Collapse
|
23
|
Duffy SA, Cummins SE, Fellows JL, Harrington KF, Kirby C, Rogers E, Scheuermann TS, Tindle HA, Waltje AH. Fidelity monitoring across the seven studies in the Consortium of Hospitals Advancing Research on Tobacco (CHART). Tob Induc Dis 2015; 13:29. [PMID: 26336372 PMCID: PMC4557818 DOI: 10.1186/s12971-015-0056-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/20/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This paper describes fidelity monitoring (treatment differentiation, training, delivery, receipt and enactment) across the seven National Institutes of Health-supported Consortium of Hospitals Advancing Research on Tobacco (CHART) studies. The objectives of the study were to describe approaches to monitoring fidelity including treatment differentiation (lack of crossover), provider training, provider delivery of treatment, patient receipt of treatment, and patient enactment (behavior) and provide examples of application of these principles. METHODS Conducted between 2010 and 2014 and collectively enrolling over 9500 inpatient cigarette smokers, the CHART studies tested different smoking cessation interventions (counseling, medications, and follow-up calls) shown to be efficacious in Cochrane Collaborative Reviews. The CHART studies compared their unique treatment arm(s) to usual care, used common core measures at baseline and 6-month follow-up, but varied in their approaches to monitoring the fidelity with which the interventions were implemented. RESULTS Treatment differentiation strategies included the use of a quasi-experimental design and monitoring of both the intervention and control group. Almost all of the studies had extensive training for personnel and used a checklist to monitor the intervention components, but the items on these checklists varied widely and were based on unique aspects of the interventions, US Public Health Service and Joint Commission smoking cessation standards, or counselor rapport. Delivery of medications ranged from 31 to 100 % across the studies, with higher levels from studies that gave away free medications and lower levels from studies that sought to obtain prescriptions for the patient in real world systems. Treatment delivery was highest among those studies that used automated (interactive voice response and website) systems, but this did not automatically translate into treatment receipt and enactment. Some studies measured treatment enactment in two ways (e.g., counselor or automated system report versus patient report) showing concurrence or discordance between the two measures. CONCLUSION While fidelity monitoring can be challenging especially in dissemination trials, the seven CHART studies used a variety of methods to enhance fidelity with consideration for feasibility and sustainability. TRIAL REGISTRATION Dissemination of Tobacco Tactics for hospitalized smokers. Clinical Trials Registration No. NCT01309217.Smoking cessation in hospitalized smokers. Clinical Trials Registration No. NCT01289275.Using "warm handoffs" to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial. Clinical Trials Registration No. NCT01305928.Web-based smoking cessation intervention that transitions from inpatient to outpatient. Clinical Trials Registration No. NCT01277250.Effectiveness of smoking-cessation interventions for urban hospital patients. Clinical Trials Registration No. NCT01363245.Comparative effectiveness of post-discharge interventions for hospitalized smokers. Clinical Trials Registration No. NCT01177176.Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals. Clinical Trials Registration No. NCT01236079.
Collapse
Affiliation(s)
- Sonia A. Duffy
- />Ohio State University, College of Nursing, Newton Hall, 1585 Neil Ave, Columbus, OH 43210 USA
- />VA Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI 48105 USA
| | - Sharon E. Cummins
- />Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, MC0905, La Jolla, CA 92093 USA
| | - Jeffrey L. Fellows
- />Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227 USA
| | - Kathleen F. Harrington
- />Division of Pulmonary Medicine, University of Alabama at Birmingham, 1900 University Blvd., THT541-G1, Birmingham, AL 35294-0006 USA
| | - Carrie Kirby
- />Moores Cancer Center, University of California, San Diego, 9500 Gilman Drive, MC0905, La Jolla, CA 92093 USA
| | - Erin Rogers
- />Department of Population Health, New York University School of Medicine, 227 E. 30th St., New York, NY & VA New York Harbor Healthcare System, 423 E. 23rd St., New York, NY USA
| | - Taneisha S. Scheuermann
- />Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 USA
| | - Hilary A. Tindle
- />Department of Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 370, Nashville, TN 37203 USA
| | - Andrea H. Waltje
- />University of Michigan, Internal Medicine, Brehm Tower, Room 6115, 1000 Wall Street, Ann Arbor, MI 48109-5714 USA
| | - the Consortium of Hospitals Advancing Research on Tobacco (CHART)
- />Ohio State University, College of Nursing, Newton Hall, 1585 Neil Ave, Columbus, OH 43210 USA
- />VA Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI 48105 USA
- />Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, MC0905, La Jolla, CA 92093 USA
- />Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227 USA
- />Division of Pulmonary Medicine, University of Alabama at Birmingham, 1900 University Blvd., THT541-G1, Birmingham, AL 35294-0006 USA
- />Moores Cancer Center, University of California, San Diego, 9500 Gilman Drive, MC0905, La Jolla, CA 92093 USA
- />Department of Population Health, New York University School of Medicine, 227 E. 30th St., New York, NY & VA New York Harbor Healthcare System, 423 E. 23rd St., New York, NY USA
- />Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 USA
- />Department of Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 370, Nashville, TN 37203 USA
- />University of Michigan, Internal Medicine, Brehm Tower, Room 6115, 1000 Wall Street, Ann Arbor, MI 48109-5714 USA
| |
Collapse
|
24
|
Meier A, McGovern MP, Lambert-Harris C, McLeman B, Franklin A, Saunders EC, Xie H. Adherence and competence in two manual-guided therapies for co-occurring substance use and posttraumatic stress disorders: clinician factors and patient outcomes. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:527-34. [PMID: 26286351 PMCID: PMC4698972 DOI: 10.3109/00952990.2015.1062894] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The challenges of implementing and sustaining evidence-based therapies into routine practice have been well-documented. OBJECTIVES This study examines the relationship among clinician factors, quality of therapy delivery, and patient outcomes. METHODS Within a randomized controlled trial, 121 patients with current co-occurring substance use and posttraumatic stress disorders were allocated to receive either manualized Integrated Cognitive Behavioral Therapy (ICBT) or Individual Addiction Counseling (IAC). Twenty-two clinicians from seven addiction treatment programs were trained and supervised to deliver both therapies. Clinician characteristics were assessed at baseline; clinician adherence and competence were assessed over the course of delivering both therapies; and patient outcomes were measured at baseline and 6-month follow-up. RESULTS Although ICBT was delivered at acceptable levels, clinicians were significantly more adherent to IAC (p < 0.05). At session 1, clinical female gender (p < 0.05) and lower education level (p < 0.05) were predictive of increased clinician adherence and competence across both therapies. Adherence and competence at session 1 in either therapy were significantly predictive of positive patient outcomes. ICBT adherence (p < 0.05) and competence (p < 0.01) were predictive of PTSD symptom reduction, whereas IAC adherence (p < 0.01) and competence (p < 0.01) were associated with decreased drug problem severity. CONCLUSIONS The differential impact of adherence and competence for both therapy types is consistent with their purported primary target: ICBT for PTSD and IAC for substance use. These findings also suggest the benefits of considering clinician factors when implementing manual-guided therapies. Future research should focus on diverse clinician samples, randomization of clinicians to therapy type, and prospective designs to evaluate models of supervision and quality monitoring.
Collapse
Affiliation(s)
- Andrea Meier
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Mark P. McGovern
- Departments of Psychiatry and of Community & Family Medicine, Geisel School of Medicine at Dartmouth, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Chantal Lambert-Harris
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Bethany McLeman
- Dartmouth Psychiatric Research Center, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Anna Franklin
- Dartmouth College, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Elizabeth C. Saunders
- Dartmouth Psychiatric Research Center, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Haiyi Xie
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| |
Collapse
|
25
|
Campbell BK, Guydish J, Le T, Wells EA, McCarty D. The relationship of therapeutic alliance and treatment delivery fidelity with treatment retention in a multisite trial of twelve-step facilitation. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 29:106-13. [PMID: 25134056 DOI: 10.1037/adb0000008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined associations of therapeutic alliance and treatment delivery fidelity with treatment retention in Stimulant Abusers to Engage in Twelve-Step (STAGE-12), a community-based trial of 12-Step Facilitation (TSF) conducted within the National Drug Abuse Treatment Clinical Trials Network (CTN). The STAGE-12 trial randomized 234 stimulant abusers enrolled in 10 outpatient drug treatment programs to an eight-session, group and individual TSF intervention. During the study, TSF participants rated therapeutic alliance using the Helping Alliance questionnaire-II. After the study, independent raters evaluated treatment delivery fidelity of all TSF sessions on adherence, competence, and therapist empathy. Poisson regression modeling examined relationships of treatment delivery fidelity and therapeutic alliance with treatment retention (measured by number of sessions attended) for 174 participants with complete fidelity and alliance data. Therapeutic alliance (p = .005) and therapist competence (p = .010) were significantly associated with better treatment retention. Therapist adherence was associated with poorer retention in a nonsignificant trend (p = .061). In conclusion, stronger therapeutic alliance and higher therapist competence in the delivery of a TSF intervention were associated with better treatment retention whereas treatment adherence was not. Training and fidelity monitoring of TSF should focus on general therapist skills and therapeutic alliance development to maximize treatment retention. (PsycINFO Database Record
Collapse
Affiliation(s)
- Barbara K Campbell
- Department of Public Health and Preventive Medicine, Oregon Health and Science University
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco
| | | | - Dennis McCarty
- Department of Public Health and Preventive Medicine, Oregon Health and Science University
| |
Collapse
|
26
|
Martino S. Credibility and treatment fidelity may matter in twelve-step treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2013; 39:273-4. [PMID: 23968168 DOI: 10.3109/00952990.2013.816721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Steve Martino
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA.
| |
Collapse
|