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Xu H, Cai J, Sawhney R, Jiang S, Buys N, Sun J. The Effectiveness of Cognitive-Behavioral Therapy in Helping People on Sick Leave to Return to Work: A Systematic Review and Meta-analysis. JOURNAL OF OCCUPATIONAL REHABILITATION 2024; 34:4-36. [PMID: 37067701 PMCID: PMC10899273 DOI: 10.1007/s10926-023-10116-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Previous research has systematically studied the effectiveness of Cognitive Behavioral Therapy (CBT)-based interventions in managing both mental and physical symptoms of chronic disease including depression, stress-related mental disorders (SMD), and chronic pain that are common causes of sick leave. However, a systematic review focusing on the effectiveness of CBT in facilitating RTW is lacking. This study compiles research on utilizing CBT-based interventions for helping employees on sick leave return to work. METHODS Randomized controlled trials (RCT) published between 1 January 1990 and 27 June 2022 were searched in MEDLINE, EMBASE, The Cochrane Library, Scopus, PsycINFO, Web of Science, and PubMed. The primary outcome variables included a return to work (RTW) measure and sickness absences. The secondary outcomes include psychological conditions (mental illness, stress, anxiety, and depression) and physical condition (working ability, fatigue, and physical function). RESULTS Thirty-four RCTs were included in the analysis. Fifteen RCTs with 1727 participants reported on sick leave. Results showed that participants who completed CBT intervention had reduced sick leave in days (mean reduction - 3.654; 95%CI - 5.253, - 2.046; p < 0.001) compared to the control group. Sixteen papers with 2298 participants reported that the intervention group RTW 1.5 days earlier (95%CI 1.019, 1.722; p < 0.05). CBT-based interventions were effective in managing fatigue, mental illness, and depression, and improving physical function while it showed no effects in managing stress, anxiety and working ability. CONCLUSIONS The findings indicate that CBT-based interventions are effective in reducing the length of sick leave and facilitating the RTW of employees in the intervention group.
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Affiliation(s)
- Huaying Xu
- School of Medicine and Dentistry, Griffith University, Nathan, Q4215, Australia
| | - Jinxuan Cai
- School of Medicine and Dentistry, Griffith University, Nathan, Q4215, Australia
| | - Rakshat Sawhney
- School of Medicine and Dentistry, Griffith University, Nathan, Q4215, Australia
| | - Stephen Jiang
- School of Medicine and Dentistry, Griffith University, Nathan, Q4215, Australia
| | - Nicholas Buys
- Centre for Work, Organisation and Wellbing, Griffith University, Nathan, Q4215, Australia
| | - Jing Sun
- School of Medicine and Dentistry, Griffith University, Nathan, Q4215, Australia.
- Institute for Integrated Intelligence and Systems, Griffith University, Nathan, Q4215, Australia.
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Eiraldi R, Lawson GM, Glick HA, Khanna MS, Beidas R, Fishman J, Rabenau-McDonnell Q, Wilson T, Comly R, Schwartz BS, Jawad AF. Implementation fidelity, student outcomes, and cost-effectiveness of train-the-trainer strategies for Masters-level therapists in urban schools: results from a cluster randomized trial. Implement Sci 2024; 19:4. [PMID: 38273369 PMCID: PMC10809609 DOI: 10.1186/s13012-023-01333-9] [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: 02/02/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Little is known about the effectiveness and cost-effectiveness of train-the-trainer implementation strategies in supporting mental health evidence-based practices in schools, and about the optimal level of support needed for TT strategies. METHODS The current study is part of a larger type 2 hybrid cluster randomized controlled trial. It compares two train-the-trainer strategies, Train-the-Trainer (TT) and Train-the-Trainer plus ongoing consultation for trainers (TT +) on the delivery of a group cognitive behavioral treatment protocol for anxiety disorders. Participants were 33 therapists, 29 supervisors, and 125 students who were at risk for anxiety disorders from 22 urban schools. Implementation outcomes were implementation fidelity and treatment dosage. Student outcomes were child- and parent-reported symptoms of anxiety, child-reported symptoms of depression, and teacher-reported academic engagement. We estimated the cost of implementing the intervention in each condition and examined the probability that a support strategy for supervisors (TT vs TT +) is a good value for varying values of willingness to pay. RESULTS Therapists in the TT and TT + conditions obtained similarly high implementation fidelity and students in the conditions received similar treatment dosages. A mixed effects modeling approach for student outcomes revealed time effects for symptoms of anxiety and depression reported by students, and emotional disaffection reported by teachers. There were no condition or condition × times effects. For both conditions, the time effects indicated an improvement from pre-treatment to post-treatment in symptoms of anxiety and depression and academic emotional engagement. The average cost of therapist, supervisor, and consultant time required to implement the intervention in each condition was $1002 for TT and $1431 for TT + (p = 0.01). There was a greater than 80% chance that TT was a good value compared to TT + for all values of willingness to pay per one-point improvement in anxiety scores. CONCLUSIONS A TT implementation approach consisting of a thorough initial training workshop for therapists and supervisors as well as ongoing supervision for therapists resulted in adequate levels of fidelity and student outcomes but at a lower cost, compared to the TT + condition that also included ongoing external expert consultation for supervisors. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02651402.
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Affiliation(s)
- Ricardo Eiraldi
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA.
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St, Philadelphia, PA, 19104, USA.
| | - Gwendolyn M Lawson
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St, Philadelphia, PA, 19104, USA
| | - Henry A Glick
- Department of Biostatistics and Epidemiology, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA, 19104, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Wharton School, University of Pennsylvania, 3620 Locust Walk, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locus Walk # 210, Philadelphia, PA, 19104, USA
| | - Muniya S Khanna
- OCD and Anxiety Institute, 3138 Butler Pike # 200, Plymouth Meeting, PA, 19462, USA
| | - Rinad Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 North Michigan Avenue, Chicago, IL, 60611, USA
| | - Jessica Fishman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St, Philadelphia, PA, 19104, USA
- Message Effects Lab, Annenberg School for Communication, University of Pennsylvania, 3620 Walnut Street, Philadelphia, PA, 19104, USA
| | - Quinn Rabenau-McDonnell
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
| | - Tara Wilson
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
| | - Rachel Comly
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
| | - Billie S Schwartz
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
| | - Abbas F Jawad
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
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Frank HE, Cruden G, Crane ME. Private Practice, Private Insurance, and Private Pay Mental Health Services: An Understudied Area in Implementation Science. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:1-6. [PMID: 37880471 PMCID: PMC11065429 DOI: 10.1007/s10488-023-01306-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/27/2023]
Abstract
The private practice setting is understudied. Private practice includes settings in which mental health providers are unaffiliated with healthcare and hospital systems. Private practices may accept insurance (private and sometimes public) or no insurance (private pay). Increasing attention to this setting is critical to facilitating equitable access to mental health services, especially given enduring mental health workforce shortages and service waitlists. Further, there have been recent federal government calls to increase mental health and physical healthcare parity and to reduce out-of-pocket patient costs. Implementation science theories, models, frameworks, and methods can help illuminate determinants of private practice service availability and quality (e.g., evidence-based intervention delivery with fidelity), guide evaluation of implementation outcomes such as cost and acceptability of interventions to patients, and identify strategies to mitigate barriers to high-quality, affordable private practice services. This article suggests research questions to begin filling the private practice research gap using an implementation determinants framework - the Consolidated Framework for Implementation Research (CFIR) 2.0. Research questions are proposed across CFIR domains: outer context (e.g., policies impacting whether private practices accept insurance); individuals involved (e.g., provider professional experiences; direct-to-consumer marketing impacts on evidence-based intervention demand); innovation characteristics (e.g., appropriateness for private practice); inner context (e.g., organizational characteristics); and implementation processes (e.g., innovation sustainability). The illustrative research questions aim to begin a conversation amongst researchers and funders. Bringing an implementation science lens to the private practice context has the potential to improve the quality and affordability of mental health care for many.
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Affiliation(s)
- Hannah E Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Gracelyn Cruden
- Chestnut Health Systems, Lighthouse Institute-Oregon Group, 1255 Pearl St, Eugene, OR, 97401, USA.
| | - Margaret E Crane
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Wislocki K, Jager-Hyman S, Brady M, Weiss M, Schaechter T, Khazanov G, Young S, Becker-Haimes E. Freely Available Training Videos for Suicide Prevention: Scoping Review. JMIR Ment Health 2023; 10:e48404. [PMID: 37921847 PMCID: PMC10656652 DOI: 10.2196/48404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Freely available and asynchronous implementation supports can reduce the resource burden of evidence-based practice training to facilitate uptake. Freely available web-based training videos have proliferated, yet there have been no efforts to quantify their breadth, depth, and content for suicide prevention. OBJECTIVE This study presents results from a scoping review of freely available training videos for suicide prevention and describes a methodological framework for reviewing such videos. METHODS A scoping review of freely available training videos (≥2 minutes) for suicide prevention practices was conducted using 4 large video-sharing platforms: YouTube, Vimeo, Bing Video, and Google Video. Identified suicide prevention training videos (N=506) were reviewed and coded. RESULTS Most content was targeted toward gatekeepers or other lay providers (n=370) versus clinical providers (n=136). Videos most commonly provided content related to suicidal thoughts or behaviors (n=420). Many videos (n=274, 54.2%) included content designed for certain communities or organizations. Less than half (n=232, 45.8%) of training videos included formal clinical content pertaining to assessment or intervention for suicide prevention. CONCLUSIONS Results suggested an abundance of videos providing broad informational content (eg, "signs and symptoms of someone at risk for suicide") and a limited portion of videos with instructional content aimed at clinical providers delivering formal evidence-based assessments or interventions for suicide prevention. Development of resources to address identified gaps may be needed. Future work may leverage machine learning techniques to expedite the review process.
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Affiliation(s)
- Katherine Wislocki
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Shari Jager-Hyman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Megan Brady
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Michal Weiss
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Temma Schaechter
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Gabriela Khazanov
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
- Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Sophia Young
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Emily Becker-Haimes
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, PA, United States
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Crane ME, Kendall PC, Chorpita BF, Sanders MR, Miller AR, Webster-Stratton C, McWilliam J, Beck JS, Ashen C, Embry DD, Pickering JA, Daleiden EL. The role of implementation organizations in scaling evidence-based psychosocial interventions. Implement Sci 2023; 18:24. [PMID: 37349845 PMCID: PMC10288683 DOI: 10.1186/s13012-023-01280-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND To bring evidence-based interventions (EBIs) to individuals with behavioral health needs, psychosocial interventions must be delivered at scale. Despite an increasing effort to implement effective treatments in communities, most individuals with mental health and behavioral problems do not receive EBIs. We posit that organizations that commercialize EBIs play an important role in disseminating EBIs, particularly in the USA. The behavioral health and implementation industry is growing, bringing the implementation field to an important inflection point: how to scale interventions to improve access while maintaining EBI effectiveness and minimizing inequities in access to psychosocial intervention. MAIN BODY We offer a first-hand examination of five illustrative organizations specializing in EBI implementation: Beck Institute for Cognitive Behavioral Therapy; Incredible Years, Inc.; the PAXIS Institute; PracticeWise, LLC; and Triple P International. We use the Five Stages of Small Business Growth framework to organize themes. We discuss practical structures (e.g., corporate structures, intellectual property agreements, and business models) and considerations that arise when trying to scale EBIs including balancing fidelity and reach of the intervention. Business models consider who will pay for EBI implementation and allow organizations to scale EBIs. CONCLUSION We propose research questions to guide scaling: understanding the level of fidelity needed to maintain efficacy, optimizing training outcomes, and researching business models to enable organizations to scale EBIs.
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Affiliation(s)
- Margaret E Crane
- Department of Psychology, Temple University, Weiss Hall, 1701 N 13th St, Philadelphia, PA, 19122, USA.
- Department of Psychiatry, New York Presbyterian-Weill Cornell Medicine, 425 E 61st St, New York, NY, 10065, USA.
| | - Philip C Kendall
- Department of Psychology, Temple University, Weiss Hall, 1701 N 13th St, Philadelphia, PA, 19122, USA.
| | - Bruce F Chorpita
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA
- PracticeWise, LLC, 410 Coach Rd, Satellite Beach, FL, 32937, USA
| | - Matthew R Sanders
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, St Lucia, QLD, 4067, Australia
| | - Allen R Miller
- Beck Institute for Cognitive Behavior Therapy, 1 Belmont Ave #700, Bala Cynwyd, PA, 19004, USA
| | | | - Jenna McWilliam
- Triple P International, 11 Market St N, Indooroopilly, QLD, 4068, Australia
| | - Judith S Beck
- Beck Institute for Cognitive Behavior Therapy, 1 Belmont Ave #700, Bala Cynwyd, PA, 19004, USA
| | - Ceth Ashen
- C. Ashen Consulting, 222 North Canon Dr. Ste 205, Beverly Hills, CA, 90210, USA
| | | | | | - Eric L Daleiden
- PracticeWise, LLC, 410 Coach Rd, Satellite Beach, FL, 32937, USA
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Cidav Z, Mandell D, Ingersoll B, Pellecchia M. Programmatic Costs of Project ImPACT for Children with Autism: A Time-Driven Activity Based Costing Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:402-416. [PMID: 36637638 PMCID: PMC9838366 DOI: 10.1007/s10488-022-01247-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/14/2023]
Abstract
Programmatic cost assessment of clinical interventions can inform future dissemination and implementation efforts. We conducted a randomized trial of Project ImPACT (Improving Parents As Communication Teachers) in which community early intervention (EI) providers coached caregivers in techniques to improve young children's social communication skills. We estimated implementation and intervention costs while demonstrating an application of Time-Driven Activity-Based Costing (TDABC). We defined Project ImPACT implementation and intervention as processes that can be broken down successively into a set of procedures. We created process maps for both implementation and intervention delivery. We determined resource use and costs, per unit procedure in the first year of the program, from a payer perspective. We estimated total implementation cost per clinician and per site, intervention cost per child, and provided estimates of total hours spent and associated costs for implementation strategies, intervention activities and their detailed procedures. Total implementation cost was $43,509 per clinic and $14,503 per clinician. Clinician time (60%) and coach time (12%) were the most expensive personnel resources. Implementation coordination and monitoring (47%), ongoing consultation (26%) and clinician training (19%) comprised most of the implementation cost, followed by fidelity assessment (7%), and stakeholder engagement (1%). Per-child intervention costs were $2619 and $9650, respectively, at a dose of one hour per week and four hours per week Project ImPACT. Clinician and clinic leader time accounted for 98% of per child intervention costs. Highest cost intervention activity was ImPACT delivery to parents (89%) followed by assessment for child's ImPACT eligibility (10%). The findings can be used to inform funding and policy decision-making to enhance early intervention options for young children with autism. Uncompensated time costs of clinicians are large which raises practical and ethical concerns and should be considered in planning of implementation initiatives. In program budgeting, decisionmakers should anticipate resource needs for coordination and monitoring activities. TDABC may encourage researchers to assess costs more systematically, relying on process mapping and gathering prospective data on resource use and costs concurrently with their collection of other trial data.
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Affiliation(s)
- Zuleyha Cidav
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - David Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Brooke Ingersoll
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Melanie Pellecchia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Julian JM, Held JI, Hixson K, Conn BM. The Implementation of Narrative Exposure Therapy (NET) for Transgender and Gender Diverse Adolescents and Young Adults. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023:1-10. [PMID: 37359461 PMCID: PMC10009357 DOI: 10.1007/s40653-023-00530-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 06/28/2023]
Abstract
Purpose There is limited information available regarding the use of trauma modalities within the transgender and gender diverse community (TGD) to address gender-based trauma, including discrimination and invalidation, particularly for adolescents and young adults (AYA). The purpose of this paper is to describe a novel treatment approach to addressing post-traumatic stress disorder (PTSD) symptoms within TGD AYA, inclusive of gender-based trauma. Methods Narrative Exposure Therapy (NET) was implemented as a brief intervention for TGD AYA who had a positive screening for PTSD symptomatology. Measures were used to assess PTSD symptoms, as well as changes in self-perceived resilience and positive well-being. Two case vignettes are provided to demonstrate the adaptations made to be responsive to the unique needs of TGD AYA for trauma processing. Results Preliminary outcomes from two case studies indicate the strength of NET when working with TGD AYA who face multiple traumatic events and continue to experience invalidation. Conclusion NET shows promise as an effective brief intervention to reduce PTSD symptomology and increase resiliency in TGD AYA.
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Affiliation(s)
- Jamie M. Julian
- Division of Adolescent and Young Adult Medicine, Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - Jordan I. Held
- Division of Adolescent and Young Adult Medicine, Children’s Hospital Los Angeles, Los Angeles, CA USA
| | | | - Bridgid M. Conn
- Division of Adolescent and Young Adult Medicine, Children’s Hospital Los Angeles, Los Angeles, CA USA
- Division of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
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Henrich D, Glombiewski JA, Scholten S. Systematic review of training in cognitive-behavioral therapy: Summarizing effects, costs and techniques. Clin Psychol Rev 2023; 101:102266. [PMID: 36963208 DOI: 10.1016/j.cpr.2023.102266] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/09/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
With the steadily growing importance of psychotherapeutic care, there is also an increasing need for high-quality training. We analyze the literature published between 2009 and 2022 on the effectiveness of training in cognitive behavioral therapy. The review addresses current gaps in the literature by focusing on the description of specific training components and their associated costs, as well as examining therapist-level predictors of training effectiveness. Our findings confirm the effect of additional supervision on both therapist competence and patient outcomes. Instructor-led training and self-guided web-based training seem to moderately increase competence, especially when targeting specific and highly structured treatments or skills. The level of prior training and experience of a therapist appears to predict the strength of training-related gains in competence. Few studies analyzed the differential effect of certain elements of training (e.g., the amount of active learning strategies) and training costs were generally not reported. Future studies should replicate or expand the existing evidence on active ingredients and therapist-level predictors of training effectiveness. Costs should be systematically reported to enhance the comparability of different training strategies.
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Affiliation(s)
- Dominik Henrich
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany.
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany
| | - Saskia Scholten
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany
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Pierce ZP, Johnson ER, Kim IA, Lear BE, Mast AM, Black JM. Therapeutic interventions impact brain function and promote post-traumatic growth in adults living with post-traumatic stress disorder: A systematic review and meta-analysis of functional magnetic resonance imaging studies. Front Psychol 2023; 14:1074972. [PMID: 36844333 PMCID: PMC9948410 DOI: 10.3389/fpsyg.2023.1074972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction The present systematic review and meta-analysis explores the impacts of cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), and prolonged exposure (PE) therapy on neural activity underlying the phenomenon of post-traumatic growth for adult trauma survivors. Methods We utilized the following databases to conduct our systematic search: Boston College Libraries, PubMed, MEDLINE, and PsycINFO. Our initial search yielded 834 studies for initial screening. We implemented seven eligibility criteria to vet articles for full-text review. Twenty-nine studies remained for full-text review after our systematic review process was completed. Studies were subjected to several levels of analysis. First, pre-and post- test post-traumatic growth inventory (PTGI) scores were collected from all studies and analyzed through a forest plot using Hedges' g. Next, Montreal Neurological Institute (MNI) coordinates and t-scores were collected and analyzed using an Activation Likelihood Estimation (ALE) to measure brain function. T-scores and Hedges' g values were then analyzed using Pearson correlations to determine if there were any relationships between brain function and post-traumatic growth for each modality. Lastly, all studies were subjected to a bubble plot and Egger's test to assess risk of publication bias across the review sample. Results Forest plot results indicated that all three interventions had a robust effect on PTGI scores. ALE meta-analysis results indicated that EMDR exhibited the largest effect on brain function, with the R thalamus (t = 4.23, p < 0.001) showing robust activation, followed closely by the R precuneus (t = 4.19, p < 0.001). Pearson correlation results showed that EMDR demonstrated the strongest correlation between increased brain function and PTGI scores (r = 0.910, p < 0.001). Qualitative review of the bubble plot indicated no obvious traces of publication bias, which was corroborated by the results of the Egger's test (p = 0.127). Discussion Our systematic review and meta-analysis showed that CPT, EMDR, and PE each exhibited a robust effect on PTG impacts across the course of treatment. However, when looking closer at comparative analyses of neural activity (ALE) and PTGI scores (Pearson correlation), EMDR exhibited a more robust effect on PTG impacts and brain function than CPT and PE.
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Affiliation(s)
- Zachary P. Pierce
- School of Social Work, Boston College, Chestnut Hill, MA, United States
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
| | - Emily R. Johnson
- School of Social Work, Boston College, Chestnut Hill, MA, United States
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
| | - Isabelle A. Kim
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Brianna E. Lear
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
| | - A. Michaela Mast
- School of Social Work, Boston College, Chestnut Hill, MA, United States
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
| | - Jessica M. Black
- School of Social Work, Boston College, Chestnut Hill, MA, United States
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
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Becker-Haimes EM, Wislocki K, Schriger SH, Kratz HE, Sanchez AL, Clapp D, Frank HE. Preliminary Implementation Outcomes of a Free Online Toolkit to Support Exposure Therapy Implementation for Youth. CHILD & YOUTH CARE FORUM 2023; 52:1-18. [PMID: 36711198 PMCID: PMC9854404 DOI: 10.1007/s10566-023-09732-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/19/2022] [Accepted: 01/07/2023] [Indexed: 01/21/2023]
Abstract
Background Exposure therapy ("exposure") for youth anxiety is highly underutilized in clinical practice. Asynchronous, online implementation strategies such as online toolkits hold promise as pragmatic approaches for extending the sustainability of evidence-based interventions, but their long-term usage, perceived utility, and impact are rarely studied. Objective This study presents three-year preliminary implementation outcomes for a free, online toolkit to support exposure therapy use with youth: the Resource for Exposure for Anxiety Disordered Youth (READY; www.bravepracticeforkids.com). Implementation outcomes of interest included READY usage statistics, adoption, perceived utility, and clinician exposure use. Methods Web analytics characterized usage patterns. A survey of READY users (N = 49; M age = 34.2, 82.9% female, 71% White) assessed adoption, perceived utility, clinician exposure use, and persistent barriers to exposure use. Results In its first three years, READY had 13,543 page views across 1,731 unique users; 442 (25.6%) registered as a site user to access specialized content. Survey data suggested variability in usage and perceived utility across toolkit components. Qualitative analyses highlighted persistent exposure barriers that pointed to potential READY refinements. Conculsions Overall, READY has been accessed by hundreds of clinicians, but its impact was limited by low return to the site. This study highlights strengths and limitations of standalone online implementation supports and identifies additional steps needed to optimally support clinicians to deliver exposure to youth in need.
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Affiliation(s)
- Emily M. Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, 19104 Philadelphia, PA USA
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, USA
| | - Katherine Wislocki
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, 19104 Philadelphia, PA USA
- Department of Psychological Science, University of California Irvine, Irvine, USA
| | | | - Hilary E. Kratz
- Department of Psychology, La Salle University, Philadelphia, USA
| | - Amanda L. Sanchez
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, 19104 Philadelphia, PA USA
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, USA
- Department of Psychology, George Mason University, Fairfax, VA USA
| | - Douglas Clapp
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, USA
- Department of Psychology, La Salle University, Philadelphia, USA
| | - Hannah E. Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, USA
- Bradley Hospital, Lifespan Health System, Providence, USA
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Lawson GM, Comly R, Beidas RS, Khanna MS, Goldstein J, Brizzolara-Dove S, Wilson T, Rabenau-McDonnell Q, Eiraldi R. Therapist and supervisor perspectives about two train-the-trainer implementation strategies in schools: A qualitative study. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231190854. [PMID: 37790186 PMCID: PMC10403977 DOI: 10.1177/26334895231190854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background Train-the-trainer (TT) implementation strategies (in which designated clinicians are trained to then train others in an intervention) are promising approaches to support mental health clinician use of evidence-based interventions in school contexts. However, there is little evidence to date examining clinicians' perceptions of the acceptability and feasibility of TT strategies, or comparing clinicians' perceptions of different types of TT strategies. Methods The current study was conducted as part of a larger hybrid effectiveness-implementation trial, in which school-based therapists and supervisors received one of two different types of implementation support to implement cognitive behavioral therapy (CBT) groups for anxiety: TT (i.e., initial training for therapists and supervisors) or enhanced TT (TT+; i.e., initial training for therapists and supervisors, and ongoing external consultation for supervisors). We used applied thematic analysis to compare qualitative interview transcripts from 28 therapist interviews and 33 supervisor interviews from therapists and supervisors who received TT or TT+ support and report themes that were similar and different across the two groups. Results Most themes were similar across the TT and TT+ conditions: therapists and supervisors in both conditions perceived the group anxiety intervention as acceptable and viewed supervision as acceptable, helpful, and feasible. Therapists and supervisors in both conditions had mixed impressions of the contextual appropriateness of the group anxiety intervention, and some reported logistical challenges with weekly supervision. Some unique themes were identified among the TT+ condition, including supervisors experiencing professional growth, and therapists and supervisors perceiving supervision as critically important and enjoyable. Conclusions These results suggest that TT implementation support, using a model in which an internal supervisor receives initial training and then provides ongoing supervision, is acceptable and feasible to support a group CBT intervention in schools. The results also highlight additional benefits that therapists and supervisors perceived when supervisors received ongoing consultation. Clinical Trial Registration Information The clinical trial from which these data were derived was registered at ClinicalTrials.gov (https://clinicaltrials.gov/) prior to the time of first patient enrollment. The registration number is: NCT02651402.
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Affiliation(s)
- Gwendolyn M. Lawson
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rachel Comly
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rinad S. Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Tara Wilson
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Ricardo Eiraldi
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Last BS, Johnson C, Dallard N, Fernandez-Marcote S, Zinny A, Jackson K, Cliggitt L, Rudd BN, Mills C, Beidas RS. Implementing trauma-focused cognitive behavioral therapy in Philadelphia: A 10-year evaluation. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231199467. [PMID: 37790185 PMCID: PMC10496473 DOI: 10.1177/26334895231199467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background: In 2012, Philadelphia's Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) developed an initiative to implement an evidence-based treatment for posttraumatic stress disorder (PTSD), trauma-focused cognitive behavioral therapy (TF-CBT), across the city's behavioral health system. This report evaluates the initiative's 10-year implementation and effectiveness outcomes. Method: The Exploration, Preparation, Implementation, and Sustainment framework guided our implementation evaluation. The implementation outcomes include adoption, reach, and sustainment; these were obtained during regular evaluation data collection from publicly funded behavioral health agencies participating in the TF-CBT initiative. We analyze effectiveness outcomes (i.e., changes in PTSD symptoms) from a subset of patients receiving TF-CBT, which were collected in 6-month intervals by our research team between 2013 and 2021. Results: From 2012 to 2021, DBHIDS trained 478 clinicians in TF-CBT across 20 behavioral health agencies. During this time, 23,401 youths were screened for potentially traumatic events and PTSD symptoms, and 7,550 youths received TF-CBT. Through the TF-CBT initiative, the city expanded the network of TF-CBT providers from 3 to 20 agencies. DBHIDS sustained this network by maintaining the participation of 16 behavioral health agencies over the course of a decade. The subset of 202 youths who were evaluated to assess TF-CBT effectiveness was drawn from 94 therapists and 20 agencies across Philadelphia. All participating youths completed a baseline assessment, and 151 (75%) completed at least one follow-up assessment. Linear mixed-effects models accounting for observations nested within participants and nested within clinicians found that treatment significantly reduced PTSD symptoms. Conclusion: Between 2012 and 2021, DBHIDS successfully implemented and sustained TF-CBT across the city's behavioral health system. Adoption, reach, and sustainment of TF-CBT were high. Despite the considerable adverse experiences faced by youths seeking treatment in Philadelphia's behavioral health system, TF-CBT was effective. Future directions to improve TF-CBT implementation in the next iteration of the initiative are described.
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Affiliation(s)
- Briana S. Last
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christina Johnson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Natalie Dallard
- Community Behavioral Health, Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
| | - Sara Fernandez-Marcote
- Community Behavioral Health, Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
| | - Arturo Zinny
- Community Behavioral Health, Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
- Center for Nonviolence and Social Justice, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Kamilah Jackson
- Community Behavioral Health, Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
- Talawa International Consultants, Philadelphia, PA, USA
| | - Lauren Cliggitt
- Hall-Mercer Community Mental Health Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brittany N. Rudd
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Chynna Mills
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rinad S. Beidas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Salloum A, Lu Y, Chen H, Quast T, Cohen JA, Scheeringa MS, Salomon K, Storch EA. Stepped Care Versus Standard Care for Children After Trauma: A Randomized Non-Inferiority Clinical Trial. J Am Acad Child Adolesc Psychiatry 2022; 61:1010-1022.e4. [PMID: 35032578 PMCID: PMC9273807 DOI: 10.1016/j.jaac.2021.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 12/05/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Trauma-focused cognitive-behavioral therapy (TF-CBT) is an evidence-based therapist-led treatment for children after trauma. Parents often experience barriers to treatment engagement, including cost. Stepped care TF-CBT (SC-TF-CBT) was developed as an alternative delivery system. Step One is a parent-led therapist-assisted treatment. Step Two provides therapist-led TF-CBT for children who did not benefit from Step One and require more intensive treatment. This study compared SC-TF-CBT to standard TF-CBT in a community-based non-inferiority trial. METHOD A total of 183 children (aged 4-12 years) experiencing posttraumatic stress symptoms (PTSS) and their caregivers were randomly assigned to SC-TF-CBT or standard TF-CBT within 6 community clinics. Assessments occurred at baseline, mid- and posttreatment, and 6 and 12 months. Primary outcomes included PTSS and impairment. Secondary outcomes included severity, diagnostic status, remission, and response. Treatment cost, acceptability, and satisfaction were measured. Difference and non-inferiority tests were applied. RESULTS SC-TF-CBT participants changed at rates comparable to participants in TF-CBT for primary and secondary measures. SC-TF-CBT was non-inferior to TF-CBT for PTSS, impairment, and severity at all time points except for impairment at the 6-month assessment. Attrition did not differ between treatment arms (132 participants were completers). Baseline treatment acceptability was lower for SC-TF-CBT parents, although there was no difference in expected treatment improvements or treatment satisfaction at posttreatment. Based on regression estimates, total costs were 38.4% lower for SC-TF-CBT compared to TF-CBT, whereas recurring costs were 53.7% lower. CONCLUSION Stepped Care TF-CBT provides an alternative way to deliver treatment for some children and parents, with reduced cost for providers and parents. CLINICAL TRIAL REGISTRATION INFORMATION Stepped Care for Children after Trauma: Optimizing Treatment; https://clinicaltrials.gov; NCT02537678.
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Affiliation(s)
| | | | | | | | - Judith A Cohen
- Allegheny Health Network, Drexel University College of Medicine, Pittsburgh, Pennsylvania
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Dopp AR, Gilbert M, Silovsky J, Ringel JS, Schmidt S, Funderburk B, Jorgensen A, Powell BJ, Luke DA, Mandell D, Edwards D, Blythe M, Hagele D. Coordination of sustainable financing for evidence-based youth mental health treatments: protocol for development and evaluation of the fiscal mapping process. Implement Sci Commun 2022; 3:1. [PMID: 34983689 PMCID: PMC8724666 DOI: 10.1186/s43058-021-00234-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sustained delivery of evidence-based treatments (EBTs) is essential to addressing the public health and economic impacts of youth mental health problems, but is complicated by the limited and fragmented funding available to youth mental health service agencies (hereafter, "service agencies"). Strategic planning tools are needed that can guide these service agencies in their coordination of sustainable funding for EBTs. This protocol describes a mixed-methods research project designed to (1) develop and (2) evaluate our novel fiscal mapping process that guides strategic planning efforts to finance the sustainment of EBTs in youth mental health services. METHOD Participants will be 48 expert stakeholder participants, including representatives from ten service agencies and their partners from funding agencies (various public and private sources) and intermediary organizations (which provide guidance and support on the delivery of specific EBTs). Aim 1 is to develop the fiscal mapping process: a multi-step, structured tool that guides service agencies in selecting the optimal combination of strategies for financing their EBT sustainment efforts. We will adapt the fiscal mapping process from an established intervention mapping process and will incorporate an existing compilation of 23 financing strategies. We will then engage participants in a modified Delphi exercise to achieve consensus on the fiscal mapping process steps and gather information that can inform the selection of strategies. Aim 2 is to evaluate preliminary impacts of the fiscal mapping process on service agencies' EBT sustainment capacities (i.e., structures and processes that support sustainment) and outcomes (e.g., intentions to sustain). The ten agencies will pilot test the fiscal mapping process. We will evaluate how the fiscal mapping process impacts EBT sustainment capacities and outcomes using a comparative case study approach, incorporating data from focus groups and document review. After pilot testing, the stakeholder participants will conceptualize the process and outcomes of fiscal mapping in a participatory modeling exercise to help inform future use and evaluation of the tool. DISCUSSION This project will generate the fiscal mapping process, which will facilitate the coordination of an array of financing strategies to sustain EBTs in community youth mental health services. This tool will promote the sustainment of youth-focused EBTs.
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Affiliation(s)
- Alex R Dopp
- Department of Behavioral and Policy Sciences, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Marylou Gilbert
- Department of Behavioral and Policy Sciences, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Jane Silovsky
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Jeanne S Ringel
- Department of Economics, Sociology, and Statistics, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Susan Schmidt
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Beverly Funderburk
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Ashley Jorgensen
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School and School of Medicine, Washington University, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Douglas A Luke
- Brown School, Washington University, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - David Mandell
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Fl., Philadelphia, PA, 19104, USA
| | - Daniel Edwards
- Evidence-Based Associates, 1311 Delaware Ave, Suite 637, Washington, DC, 20024, USA
| | - Mellicent Blythe
- NC Child Treatment Program c/o Center for Child and Family Health, 1121 W, Chapel Hill St. Ste. 100, Durham, NC, 27701, USA
| | - Dana Hagele
- NC Child Treatment Program c/o Center for Child and Family Health, 1121 W, Chapel Hill St. Ste. 100, Durham, NC, 27701, USA
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15
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Frank HE, Milgram L, Freeman JB, Benito KG. Expanding the reach of evidence-based mental health interventions to private practice: Qualitative assessment using a policy ecology framework. FRONTIERS IN HEALTH SERVICES 2022; 2:892294. [PMID: 36925863 PMCID: PMC10012822 DOI: 10.3389/frhs.2022.892294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Abstract
Background Evidence-based interventions (EBIs) for mental health disorders are underutilized in routine clinical practice. Exposure therapy for anxiety disorders is one particularly difficult-to-implement EBI that has robust empirical support. Previous research has examined EBI implementation determinants in publicly funded mental health settings, but few studies have examined EBI implementation determinants in private practice settings. Private practice clinicians likely face unique barriers to implementation, including setting-specific contextual barriers to EBI use. The policy ecology framework considers broad systemic determinants, including organizational, regulatory, social, and political contexts, which are likely relevant to EBI implementation in private practice settings but have not been examined in prior research. Methods Qualitative interviews were conducted to assess private practice clinicians' perceptions of EBI implementation determinants using the policy ecology framework. Clinicians were asked about implementing mental health EBIs broadly and exposure therapy specifically. Mixed methods analyses compared responses from clinicians working in solo vs. group private practice and clinicians who reported high vs. low organizational support for exposure therapy. Results Responses highlight several barriers and facilitators to EBI implementation in private practice. Examples include determinants related to organizational support (e.g., colleagues using EBIs), payer restrictions (e.g., lack of reimbursement for longer sessions), fiscal incentives (e.g., payment for attending training), and consumer demand for EBIs. There were notable differences in barriers faced by clinicians who work in group private practices compared to those working in solo practices. Solo private practice clinicians described ways in which their practice setting limits their degree of colleague support (e.g., for consultation or exposure therapy planning), while also allowing for flexibility (e.g., in their schedules and practice location) that may not be available to clinicians in group practice. Conclusions Using the policy ecology framework provides a broad understanding of contextual factors that impact private practice clinicians' use of EBIs, including exposure therapy. Findings point to potential implementation strategies that may address barriers that are unique to clinicians working in private practice.
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Affiliation(s)
- Hannah E Frank
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Bradley Hospital, East Providence, RI, United States
| | - Lauren Milgram
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Bradley Hospital, East Providence, RI, United States
| | - Jennifer B Freeman
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Bradley Hospital, East Providence, RI, United States
| | - Kristen G Benito
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Bradley Hospital, East Providence, RI, United States
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Becker-Haimes EM, Mandell DS, Fishman J, Williams NJ, Wolk CB, Wislocki K, Reich D, Schaechter T, Brady M, Maples NJ, Creed TA. Assessing Causal Pathways and Targets of Implementation Variability for EBP use (Project ACTIVE): a study protocol. Implement Sci Commun 2021; 2:144. [PMID: 34930483 PMCID: PMC8686333 DOI: 10.1186/s43058-021-00245-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background Advancing causal implementation theory is critical for designing tailored implementation strategies that target specific mechanisms associated with evidence-based practice (EBP) use. This study will test the generalizability of a conceptual model that integrates organizational constructs and behavioral theory to predict clinician use of cognitive-behavioral therapy (CBT) techniques in community mental health centers. CBT is a leading psychosocial EBP for psychiatric disorders that remains underused despite substantial efforts to increase its implementation. Methods We will leverage ongoing CBT implementation efforts in two large public health systems (Philadelphia and Texas) to recruit 300 mental health clinicians and 600 of their clients across 40 organizations. Our primary implementation outcomes of interest are clinician intentions to use CBT and direct observation of clinician use of CBT. As CBT comprises discrete components that vary in complexity and acceptability, we will measure clinician use of six discrete components of CBT. After finishing their CBT training, participating clinicians will complete measures of organizational and behavior change constructs delineated in the model. Clinicians also will be observed twice via audio recording delivering CBT with a client. Within 48 h of each observation, theorized moderators of the intention-behavior gap will be collected via survey. A subset of clinicians who report high intentions to use CBT but demonstrate low use will be purposively recruited to complete semi-structured interviews assessing reasons for the intention-behavior gap. Multilevel path analysis will test the extent to which intentions and determinants of intention predict the use of each discrete CBT component. We also will test the extent to which theorized determinants of intention that include psychological, organizational, and contextual factors explain variation in intention and moderate the association between intentions and CBT use. Discussion Project ACTIVE will advance implementation theory, currently in its infancy, by testing the generalizability of a promising causal model of implementation. These results will inform the development of implementation strategies targeting modifiable factors that explain substantial variance in intention and implementation that can be applied broadly across EBPs.
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Affiliation(s)
- Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA. .,Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, PA, USA.
| | - David S Mandell
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Jessica Fishman
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA.,Message Effects Laboratory, Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Courtney Benjamin Wolk
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Katherine Wislocki
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Danielle Reich
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Temma Schaechter
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Megan Brady
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Natalie J Maples
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Torrey A Creed
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
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When Do Therapists Stop Using Evidence-Based Practices? Findings from a Mixed Method Study on System-Driven Implementation of Multiple EBPs for Children. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:323-337. [PMID: 31720914 DOI: 10.1007/s10488-019-00987-2] [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: 10/25/2022]
Abstract
Therapist discontinuation of delivering an evidence-based practice (EBP) is a critical outcome in the community implementation of EBPs. This mixed methods study examined factors associated with therapist discontinuation within a large reimbursement-driven implementation of multiple EBPs in public children's mental health services. The study integrated quantitative survey data from 748 therapists across 65 agencies, and qualitative interviews from a subset of 79 therapists across 14 agencies. Therapists adopted, on average, 2.41 EBPs (SD = 1.05, range = 1-5), and nearly half (n = 355, 47.5%) reported discontinuing at least one EBP. Multi-level models were used to predict the binary outcome of discontinuation, and qualitative analyses were used to expand upon quantitative findings. Quantitative models revealed that therapist factors, including fewer direct service hours per week, a greater number of EBPs adopted, higher emotional exhaustion, and more negative attitudes toward EBPs in general were associated with discontinuation. In addition, EBP-specific factors including more negative perceptions of the particular EBP and lower self-efficacy for delivering the specific EBP predicted discontinuation. Themes from interview responses highlighted the importance of fit of the EBP with the agency's client base, as well as therapist perceptions of adequate EBP training supports, and the alignment of an EBP with therapists' professional goals. Together, the findings suggest the need for strategic sustainment planning interventions that target EBP fit (i.e., fit between adopted EBPs and agency target population, fit between EBP and therapist preferences and career goals) and support therapist self-efficacy in delivering EBPs.
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Barnett ML, Lau AS, Lind T, Wright B, Stadnick N, Innes-Gomberg D, Pesanti K, Brookman-Frazee L. Caregiver Attendance as a Quality Indicator in the Implementation of Multiple Evidence-Based Practices for Children. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:868-882. [PMID: 31799862 PMCID: PMC7269837 DOI: 10.1080/15374416.2019.1683851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study investigated a quality indicator for children's mental health, caregiver attendance in youth psychotherapy sessions, within a system-driven implementation of multiple evidence-based practices (EBPs) in children's community mental health services. METHOD Administrative claims from nine fiscal years were analyzed to characterize and predict caregiver attendance. Data included characteristics of therapists (n = 8,626), youth clients (n = 134,368), sessions (e.g., individual, family), and the EBP delivered. Clients were primarily Latinx (63%), male (54%) and mean age was 11; they presented with a range of mental health problems. Three-level mixed models were conducted to examine the association between therapist, youth, service, EBP characteristics and caregiver attendance. RESULTS Caregivers attended, on average, 46.0% of sessions per client for the full sample and 59.6% of sessions for clients who were clinically indicated, based on age and presenting problem, to receive caregiver-focused treatment. Following initial EBP implementation, the proportion of caregiver attendance in sessions increased over time. Caregivers attended a higher proportion of youth psychotherapy sessions when clients were younger, had an externalizing disorder, were non-Hispanic White, and were male. Further, higher proportions of caregiver attendance occurred when services were delivered in a clinic setting (compared with school and other settings), by bilingual therapists, and the EBP prescribed caregiver attendance in all sessions. CONCLUSIONS Overall, the patterns of caregiver attendance appear consistent with evidence-informed practice parameters of client presenting problem and age. Yet, several improvement targets emerged such as client racial/ethnic background and service setting. Potential reasons for these disparities are discussed.
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Affiliation(s)
- Miya L. Barnett
- University of California, Santa Barbara, Department of Counseling, Clinical, & School Psychology, Santa Barbara, CA
| | - Anna S. Lau
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA
| | - Teresa Lind
- University of California, San Diego, Department of Psychiatry; Child and Adolescent Services Research Center, San Diego, CA
| | - Blanche Wright
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA
| | - Nicole Stadnick
- University of California, San Diego, Department of Psychiatry; Child and Adolescent Services Research Center, San Diego, CA
| | | | - Keri Pesanti
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Lauren Brookman-Frazee
- University of California, San Diego, Department of Psychiatry; Child and Adolescent Services Research Center, San Diego, CA
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Bettis AH, Liu RT, Walsh BW, Klonsky ED. Treatments for Self-Injurious Thoughts and Behaviors in Youth: Progress and Challenges. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2020; 5:354-364. [PMID: 32923664 DOI: 10.1080/23794925.2020.1806759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Self-injurious thoughts and behaviors (SITBs) remain a common clinical problem in youth. This article reviews the state of knowledge regarding psychosocial treatments for SITBs in youth. Broadly speaking, psychosocial treatments that incorporate parents/family and that emphasize skills development (including emotion regulation and interpersonal skills) appear to produce the best outcomes. We also describe several challenges to the implementation of evidence-based psychotherapy, as well as potential solutions to these challenges, and provide an illustrative case example. Finally, because even evidence-based psychosocial treatments can take weeks to produce effects, increased attention has been given to biological approaches such as esketamine administration and transcranial direct current stimulation that have potential to yield rapid improvement for acute suicidal ideation, though evidence for the safety and efficacy of these approaches is in the early stages.
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Affiliation(s)
- Alexandra H Bettis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Richard T Liu
- Department of Psychiatry, Massachusetts General Hospital; Department of Psychiatry, Harvard Medical School
| | - Barent W Walsh
- Executive Director Emeritus and Senior Clinical Consultant, Open Sky Community Services
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Frank HE, Becker-Haimes EM, Kendall PC. Therapist training in evidence-based interventions for mental health: A systematic review of training approaches and outcomes. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020; 27:e12330. [PMID: 34092941 PMCID: PMC8174802 DOI: 10.1111/cpsp.12330] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/07/2020] [Indexed: 12/20/2022]
Abstract
A lack of effective therapist training is a major barrier to evidence-based intervention (EBI) delivery in the community. Systematic reviews published nearly a decade ago suggested that traditional EBI training leads to higher knowledge but not more EBI use, indicating that more work is needed to optimize EBI training and implementation. This systematic review synthesizes the training literature published since 2010 to evaluate how different training models (workshop, workshop with consultation, online training, train-the-trainer, and intensive training) affect therapists' knowledge, beliefs, and behaviors. Results and limitations for each approach are discussed. Findings show that training has advanced beyond provision of manuals and brief workshops; more intensive training models show promise for changing therapist behavior. However, methodological issues persist, limiting conclusions and pointing to important areas for future research.
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Affiliation(s)
- Hannah E. Frank
- Psychology Department, Temple University, Philadelphia, Pennsylvania
| | - Emily M. Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Hall Mercer Community Mental Health, Philadelphia, Pennsylvania
| | - Philip C. Kendall
- Psychology Department, Temple University, Philadelphia, Pennsylvania
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Dopp AR, Mundey P, Silovsky JF, Hunter M, Slemaker A. Economic value of community-based services for problematic sexual behaviors in youth: A mixed-method cost-effectiveness analysis. CHILD ABUSE & NEGLECT 2020; 105:104043. [PMID: 31239075 DOI: 10.1016/j.chiabu.2019.104043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 03/29/2019] [Accepted: 06/10/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Problematic sexual behavior in youth represents a significant public health problem in need of evidence-based treatments. Unfortunately, such treatments are not available in most communities. OBJECTIVE This study used a mixed quantitative-qualitative approach to investigate the economics of the implementation of Problematic Sexual Behavior - Cognitive-Behavioral Therapy (PSB-CBT), an evidence-based treatment for problem sexual behaviors in youth. PARTICIPANTS AND SETTING Youth (N = 413) participated in PSB-CBT at six program sites in youth service agencies across the United States. METHOD We used cost-effectiveness ratios (CERs) to compare the direct and indirect costs of PSB-CBT to self- and caregiver-reported youth clinical outcomes (i.e., problem sexual behavior as well as secondary behavioral health problems). CERs represented the cost of achieving one standard unit of change on a measure (i.e., d = 1.0). The design and interpretation of those quantitative analyses were informed by qualitative themes about program costs and benefits that were derived from interviews with 59 therapists, administrators, and stakeholders. RESULTS CERs (i.e., $ per SD) were $1,772 per youth for problem sexual behavior and ranged from $2,867 to $4,899 per youth for secondary outcomes. These quantitative results, considered alongside the qualitative perspectives of interviewees, suggested that the implementation of PSB-CBT was cost-effective. The results were robust to uncertainty in key parameters under most, but not all, conditions. CONCLUSIONS The results have important implications for decisions made by administrators, policymakers, and therapists regarding use of community-based approaches to address problematic sexual behavior of youth.
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Affiliation(s)
- Alex R Dopp
- Department of Psychological Science, University of Arkansas, United States.
| | - Peter Mundey
- Department of Pediatrics, University of Oklahoma Health Sciences Center, United States
| | - Jane F Silovsky
- Department of Pediatrics, University of Oklahoma Health Sciences Center, United States
| | - Michael Hunter
- Department of Pediatrics, University of Oklahoma Health Sciences Center, United States
| | - Alexandra Slemaker
- Department of Pediatrics, University of Oklahoma Health Sciences Center, United States
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Acri MC, Bornheimer LA, Hamovitch EK, Lambert K. Outcomes Associated With Adapting a Research-Supported Treatment for Children With Behavior Disorders. RESEARCH ON SOCIAL WORK PRACTICE 2020; 30:74-83. [PMID: 32855587 PMCID: PMC7449371 DOI: 10.1177/1049731519841439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE The aims of this study are to describe an adaptation process of a research-supported treatment (RST) for children with oppositional defiant disorder and to examine provider attitudes toward RSTs prior to and following this process. METHOD Providers from 14 agencies in New York State delivered the adapted RST, following training. Attitudes toward RSTs were measured by the Evidence-Based Practice Attitude Scale at baseline and posttest. RESULTS Openness toward RSTs decreased from baseline to posttest. The majority of providers reported modifications to the structure and process of the intervention. DISCUSSION To improve the uptake and usability of RSTs in practice, future research must further address adaptation processes and their relationships to attitudes toward RSTs.
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Affiliation(s)
- Mary C. Acri
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY, USA
| | | | - Emily K. Hamovitch
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY, USA
| | - Kate Lambert
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY, USA
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Kuckertz JM, Silverman AL, Bullis JR, Björgvinsson T, Beard C. Awareness of and attitudes toward CBT, DBT, and ACT in an acute psychiatric sample. J Clin Psychol 2019; 76:749-768. [DOI: 10.1002/jclp.22908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jennie M. Kuckertz
- Department of PsychiatryMcLean Hospital/Harvard Medical School Belmont Massachusetts
- Joint Doctoral Program in Clinical PsychologySan Diego State University/University of California San Diego California
| | | | - Jacqueline R. Bullis
- Department of PsychiatryMcLean Hospital/Harvard Medical School Belmont Massachusetts
| | - Thröstur Björgvinsson
- Department of PsychiatryMcLean Hospital/Harvard Medical School Belmont Massachusetts
| | - Courtney Beard
- Department of PsychiatryMcLean Hospital/Harvard Medical School Belmont Massachusetts
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Kopelovich SL, Strachan E, Sivec H, Kreider V. Stepped Care as an Implementation and Service Delivery Model for Cognitive Behavioral Therapy for Psychosis. Community Ment Health J 2019; 55:755-767. [PMID: 30623294 DOI: 10.1007/s10597-018-00365-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
Cognitive behavioral therapy for schizophrenia spectrum disorders is an evidence-based treatment that is recommended by United States schizophrenia treatment guidelines. Based on recent estimates, only 0.3% of individuals with a primary psychotic disorder are able to access this treatment in the United States. Stepped care interventions have shown promise as an applied treatment delivery model in other settings and for other psychotherapeutic interventions. The current paper describes how the stepped care model can be applied to CBT for psychosis in the US to increase access to the intervention in community mental health settings by leveraging the multidisciplinary team.
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Affiliation(s)
- Sarah L Kopelovich
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 9th Avenue, Box 359911, 98104, Seattle, WA, USA.
| | - Eric Strachan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 9th Avenue, Box 359911, 98104, Seattle, WA, USA
| | - Harry Sivec
- Best Practices in Schizophrenia Treatment (BeST) Center, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Valerie Kreider
- Best Practices in Schizophrenia Treatment (BeST) Center, Northeast Ohio Medical University, Rootstown, OH, USA
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Beidas RS, Williams NJ, Becker-Haimes EM, Aarons GA, Barg FK, Evans AC, Jackson K, Jones D, Hadley T, Hoagwood K, Marcus SC, Neimark G, Rubin RM, Schoenwald SK, Adams DR, Walsh LM, Zentgraf K, Mandell DS. A repeated cross-sectional study of clinicians' use of psychotherapy techniques during 5 years of a system-wide effort to implement evidence-based practices in Philadelphia. Implement Sci 2019; 14:67. [PMID: 31226992 PMCID: PMC6588873 DOI: 10.1186/s13012-019-0912-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/03/2019] [Indexed: 02/06/2023] Open
Abstract
Background Little work investigates the effect of behavioral health system efforts to increase use of evidence-based practices or how organizational characteristics moderate the effect of these efforts. The objective of this study was to investigate clinician practice change in a system encouraging implementation of evidence-based practices over 5 years and how organizational characteristics moderate this effect. We hypothesized that evidence-based techniques would increase over time, whereas use of non-evidence-based techniques would remain static. Method Using a repeated cross-sectional design, data were collected three times from 2013 to 2017 in Philadelphia’s public behavioral health system. Clinicians from 20 behavioral health outpatient clinics serving youth were surveyed three times over 5 years (n = 340; overall response rate = 60%). All organizations and clinicians were exposed to system-level support provided by the Evidence-based Practice Innovation Center from 2013 to 2017. Additionally, approximately half of the clinicians participated in city-funded evidence-based practice training initiatives. The main outcome included clinician self-reported use of cognitive-behavioral and psychodynamic techniques measured by the Therapy Procedures Checklist-Family Revised. Results Clinicians were 80% female and averaged 37.52 years of age (SD = 11.40); there were no significant differences in clinician characteristics across waves (all ps > .05). Controlling for organizational and clinician covariates, average use of CBT techniques increased by 6% from wave 1 (M = 3.18) to wave 3 (M = 3.37, p = .021, d = .29), compared to no change in psychodynamic techniques (p = .570). Each evidence-based practice training initiative in which clinicians participated predicted a 3% increase in CBT use (p = .019) but no change in psychodynamic technique use (p = .709). In organizations with more proficient cultures at baseline, clinicians exhibited greater increases in CBT use compared to organizations with less proficient cultures (8% increase vs. 2% decrease, p = .048). Conclusions System implementation of evidence-based practices is associated with modest changes in clinician practice; these effects are moderated by organizational characteristics. Findings identify preliminary targets to improve implementation.
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Affiliation(s)
- Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Hall- Mercer Community Mental Health Center, Philadelphia, PA, USA.
| | | | - Emily M Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Hall- Mercer Community Mental Health Center, Philadelphia, FL, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Frances K Barg
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Kamilah Jackson
- Community Behavioral Health, Impact Reach, LLC, Philadelphia, PA, USA
| | - David Jones
- Department of Behavioral Health, Philadelphia, PA, USA
| | - Trevor Hadley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kimberly Hoagwood
- Department of Child and Adolescent Psychiatry, New York University Langone Health, New York, NY, USA
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Geoffrey Neimark
- Community Behavioral Health, Impact Reach, LLC, Philadelphia, PA, USA
| | - Ronnie M Rubin
- Community Behavioral Health, Impact Reach, LLC, Philadelphia, PA, USA.,Impact Reach, LLC, Philadelphia, PA, USA
| | | | - Danielle R Adams
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
| | - Lucia M Walsh
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Kelly Zentgraf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Hall- Mercer Community Mental Health Center, Philadelphia, PA, USA
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A History of Child and Adolescent Treatment Through a Distillation Lens: Looking Back to Move Forward. J Behav Health Serv Res 2019; 47:70-85. [DOI: 10.1007/s11414-019-09659-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Borderline Personality Disorder: Barriers to Borderline Personality Disorder Treatment and Opportunities for Advocacy. Psychiatr Clin North Am 2018; 41:695-709. [PMID: 30447733 DOI: 10.1016/j.psc.2018.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients experience difficulty in accessing the evidence-based treatments that exist for borderline personality disorder. This article identifies barriers to treatment within the US structural, economic, and political landscape and how families have created an advocacy movement to address this problem. It explores how the United States has addressed such barriers, in comparison to other countries. Finally, it offers recommendations for future advocacy to increase access to treatment for borderline personality disorder.
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