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Lawson GM, Mandell DS, Tomczuk L, Fishman J, Marcus SC, Pellecchia M. Clinician Intentions to use the Components of Parent Coaching Within Community Early Intervention Systems. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:357-365. [PMID: 36525093 PMCID: PMC10191901 DOI: 10.1007/s10488-022-01243-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Parent coaching is a complex, psychosocial intervention with multiple core components. Clinicians' use of these core components may be influenced by distinct factors; no research has examined whether clinician perceptions of parent coaching vary across core coaching components. This study aimed to examine the extent to which clinicians working with families of young autistic children in publicly funded early intervention intend to use core parent coaching components, and to examine how closely psychological factors relate to providers' intentions to use each component. METHODS Using the Theory of Planned Behavior as a framework, this study compared the strength of clinicians' intentions across five core parent coaching components: collaboration with parents, delivering the intervention within daily routines, demonstrating the intervention, providing in-vivo feedback, and reflection and problem solving. We examined the associations between intentions and psychological determinants of intentions (i.e., attitudes, norms, and self-efficacy) for each component. RESULTS Clinicians' average intentions varied by core component, with strongest intentions for demonstrating the intervention strategy for a parent. The associations between intentions and psychological determinants also varied by core component. Attitudes, injunctive norms, and self-efficacy, but not descriptive norms, significantly related to clinicians' intentions to use collaboration and daily routines, whereas attitudes and descriptive norms, but not injunctive norms and self-efficacy, significantly related to clinicians' intentions to use feedback and reflection and problem solving. CONCLUSION These results suggest that implementation strategies should be tailored to the specific intervention component to be most efficient and effective. The results also provide examples of potentially malleable factors that implementation strategies can strategically target.
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Affiliation(s)
- Gwendolyn M Lawson
- Children's Hospital of Philadelphia, 2716 South St, 8th Floor, Philadelphia, Pennsylvania, 19146, United States.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States.
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
| | - Liza Tomczuk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
| | - Jessica Fishman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
- Annenberg School, University of Pennsylvania, Pennsylvania, United States
| | - Steven C Marcus
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
- School of Social Policy and Practice, University of Pennsylvania, Pennsylvania, United States
| | - Melanie Pellecchia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
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Wolk CB, Becker-Haimes EM, Fishman J, Affrunti NW, Mandell DS, Creed TA. Variability in clinician intentions to implement specific cognitive-behavioral therapy components. BMC Psychiatry 2019; 19:406. [PMID: 31852471 PMCID: PMC6921500 DOI: 10.1186/s12888-019-2394-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/05/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND CBT comprises many discrete components that vary in complexity, but implementation and training efforts often approach CBT as a single entity. We examined variability in clinician intentions to use different structural and interventional components of CBT for three different clinical groups: clients receiving CBT, clients with depression, and clients with anxiety. METHODS Clinicians (n = 107) trained in CBT completed a one-time electronic survey. Clinicians' intentions were measured using established item stems from social psychology adapted to examine intentions to use six specific CBT components: exposure therapy, cognitive restructuring, behavioral activation, planning homework, reviewing homework, and agenda-setting. RESULTS Intentions were weakest, on average, for exposure. They were strongest, on average, for reviewing homework. A series of ANOVAs with Tukey's post-hoc tests revealed that participants intended to use exposure with clients receiving CBT (p = .015) and clients with anxiety (p < .001) significantly more than for clients with depression. Participants intended to use behavioral activation with clients with depression (p = .01) significantly more than for clients with anxiety. No other intentions to use CBT components differed among these three clinical populations. CONCLUSIONS When studying determinants of CBT use and designing interventions to increase use, implementers should consider that different CBT components may require different implementation strategies. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA.
| | - Emily M. Becker-Haimes
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104 USA ,Hall-Mercer Community Mental Health Center, Philadelphia, PA USA
| | - Jessica Fishman
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104 USA ,0000 0004 1936 8972grid.25879.31Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA ,0000 0004 1936 8972grid.25879.31Annenberg School for Communication, University of Pennsylvania, Philadelphia, USA
| | - Nicholas W. Affrunti
- 0000 0001 1010 7993grid.431691.8National Association of School Psychologists, Bethesda, MD USA
| | - David S. Mandell
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104 USA ,0000 0004 1936 8972grid.25879.31Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Torrey A. Creed
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104 USA
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Ameel M, Kontio R, Välimäki M. Interventions delivered by nurses in adult outpatient psychiatric care: An integrative review. J Psychiatr Ment Health Nurs 2019; 26:301-322. [PMID: 31251445 DOI: 10.1111/jpm.12543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 12/18/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: In many countries, the majority of psychiatric care is being delivered in an outpatient setting and the proportion of outpatients is increasing on a global level. Nurses are the largest workforce in psychiatric care, but their role has been said to be difficult to define. According to our knowledge, there are no previous reviews focusing on nurse-delivered interventions in the adult psychiatric outpatient setting. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This review summarizes nurse-delivered interventions identified in the research literature and describes these systematically. Analysing all the identified interventions using the Nursing Interventions Classification, we conclude that the emphasis of nurse-delivered interventions in psychiatric outpatient care is on interventions aiming at improving the functioning of both patients and their family members by building on their own strengths. These findings differ from those presented in a review on inpatient psychiatric nursing. There are several clinical trials describing nurse-delivered evidence-based treatments, such as psychoeducation for patients and their family members in the case of patients diagnosed with schizophrenia and bipolar disorder. The quality of randomized controlled trials was higher than in earlier reviews describing psychiatric nursing interventions in general or in connection with a specific patient group. Further clinical trials are needed to describe the role of nurses in the care of patients diagnosed with depression and in the use of web-based interventions. Additionally, it would be important to study what supports, and on the other hand hinders, the role of nurses in delivering evidence-based treatments at the clinical level. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses can play a central role in responding to the growing demand for evidence-based practices in adult outpatient psychiatry, by delivering treatments for patients and family members. It is important that both nursing education and clinical practices recognize and support this role. Abstract Introduction According to our knowledge, there are no previous reviews on nurse-delivered interventions in the adult psychiatric outpatient setting. Aim To identify and systematically describe and analyse nurse-delivered interventions based on research literature. Method An integrative review. Results This review included 60 studies, of which 46 were intervention studies, including 40 clinical trials. The most common patient groups were patients diagnosed with schizophrenia and bipolar disorder. The nursing interventions described in the studies resembled a total of 68 interventions from the Nursing Interventions Classification. The treatment delivery methods varied and treatments often lacked a clear theoretical background. Implications for practice The core of nurse-delivered interventions identified in research literature in psychiatric outpatient care is on interventions aiming at improving the functioning of both patients and their family members by building on their own strengths. These findings differ from the interventions identified in a review describing nursing in the inpatient setting. There are high-quality clinical trials describing nurse-delivered treatments for patients diagnosed with schizophrenia and bipolar disorder. These include evidence-based treatments such as psychoeducation. Understanding of how these treatments are transferred in clinical practice is missing. Clinical trials describing nurse-delivered web-based interventions and interventions for patients diagnosed with depression are needed.
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Affiliation(s)
- Maria Ameel
- Department of Nursing Science, University of Turku, Turku, Finland.,Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Raija Kontio
- Department of Nursing Science, University of Turku, Turku, Finland.,Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
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Abstract
Over the past few decades, the emergence of evidence-based practice medicine (EBP) has allowed a change in the integration of knowledge with policy making and health service development, and Chile has been influenced by EBP with no exemption. In this paper, we will describe the impact of the EBP model at different levels of the Chilean health system, including the development of national clinical guidelines, medical training and in-patient involvement in health awareness.
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Affiliation(s)
- Constanza Caneo
- Adult Psychiatrist, Liaison Psychiatry Unit, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Calderón
- Adult Psychiatrist, Head Liaison Psychiatry Unit, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Community Treatment Orders-A pause for thought. Asian J Psychiatr 2016; 24:1-4. [PMID: 27931888 DOI: 10.1016/j.ajp.2016.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/15/2016] [Accepted: 08/17/2016] [Indexed: 11/23/2022]
Abstract
Community Treatment Orders (CTO) have been available for several decades in some countries and are being progressively introduced worldwide, with significant uptake in Asian countries as they move more mental health care into the community. However the evidence for the effectiveness of CTOs is limited. The evidence from local audits and evaluations is conflicted with some studies showing clear benefit and others not. The same is the case for uncontrolled before and after studies. The higher levels of evidence such as randomised controlled trials, systematic reviews, and Cochrane reviews have consistently failed to demonstrate benefits from CTO use on key measures such as symptom levels, functioning, and healthcare use. Despite this they are increasingly available internationally and often greeted enthusiastically by clinicians and families who want to ensure care and follow up for the mentally ill. This article briefly discusses the evidence before describing potential alternatives to the use of compulsion that do have an evidence base, such as multidisciplinary community working, housing initiatives, and employment support.
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