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Rivera Nales CJ, Triplett NS, Woodard GS, Meza R, Valdivieso A, Goel V, Dorsey S, Berliner L, Martin P. CBT+ Training Initiative in Washington State Community Mental Health: An Evaluation of Child Clinical Outcomes. Community Ment Health J 2024; 60:649-661. [PMID: 37880492 DOI: 10.1007/s10597-023-01194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 09/23/2023] [Indexed: 10/27/2023]
Abstract
The Washington State CBT+ Initiative offers a flexible training and consultation approach for community mental health providers in evidence-based practices for four child mental health targets: cognitive behavioral therapy for depression, anxiety, trauma, and behavioral difficulties. As part of consultation, clinicians used an online system to track delivery of treatment components and clinical outcomes using standardized symptom measures. The current study used these clinician-input data to examine symptom change for children using paired sample t-tests. Additionally, we explored if time elapsed or number of sessions between measurements related to symptom change using simple linear regression. Children had significant symptom reduction across all four targets. For most measures, children did not show greater improvements with increased length of time or increased number of sessions between assessment measures. Findings suggest that children treated by a CBT+ trained clinician may demonstrate symptom reduction for their primary clinical problem. Findings add to support for flexible training approaches for community mental health clinicians.
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Affiliation(s)
- Cristian J Rivera Nales
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Noah S Triplett
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Grace S Woodard
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Rosemary Meza
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Alejandro Valdivieso
- Department of Clinical and Counseling Psychology, Columbia University, New York, NY, USA
| | - Vanshika Goel
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Prerna Martin
- Department of Psychiatry, University of California Los Angeles, Los Angeles, CA, USA
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Jensen-Doss A, Casline E, Woodard GS, Phillips DA, Lane E, Palafu T, Waye C, Ramirez V, Cheron DM, Okamura K. Provider Use of, Attitudes Towards, and Self-efficacy with Key Measurement-based Care Practices in Youth Mental Health Treatment: A Multi-site Examination. Adm Policy Ment Health 2024:10.1007/s10488-024-01354-6. [PMID: 38334881 DOI: 10.1007/s10488-024-01354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 02/10/2024]
Abstract
Measurement-based care (MBC) is an underutilized evidence-based practice, and current implementation efforts demonstrate limited success in increasing MBC use. A better understanding of MBC implementation determinants is needed to improve these efforts, particularly from studies examining the full range of MBC practices and that span multiple samples of diverse providers using different MBC systems. This study addressed these limitations by conducting a multi-site survey examining MBC predictors and use in youth treatment. Participants were 159 clinicians and care coordinators working in youth mental health care settings across the United States. Participants were drawn from three program evaluations of MBC implementation. Providers completed measures assessing use of five MBC practices (administering measures, viewing feedback, reviewing feedback in supervision, sharing feedback with clients in session, and using feedback to plan treatment), MBC self-efficacy, and MBC attitudes. Despite expectations that MBC should be standard care for all clients, providers reported only administering measures to 40-60% of clients on average, with practices related to the use of feedback falling in the 1-39% range. Higher MBC self-efficacy and more positive views of MBC practicality predicted higher MBC use, although other attitude measures were not significant predictors. Effects of predictors were not moderated by site, suggesting consistent predictors across implementation settings. Implications of study findings for future research and for the implementation of MBC are discussed.
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Affiliation(s)
| | - Elizabeth Casline
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | - Grace S Woodard
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Elizabeth Lane
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Tessa Palafu
- The Baker Center for Children and Families, Boston, MA, USA
| | - Catherine Waye
- The Baker Center for Children and Families, Boston, MA, USA
| | | | | | - Kelsie Okamura
- The Baker Center for Children and Families, Boston, MA, USA
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Woodard GS, Casline E, Ehrenreich-May J, Ginsburg GS, Jensen-Doss A. Consultation as an Implementation Strategy to Increase Fidelity of Measurement-Based Care Delivery in Community Mental Health Settings: An Observational Study. Adm Policy Ment Health 2023:10.1007/s10488-023-01321-7. [PMID: 38052929 DOI: 10.1007/s10488-023-01321-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/07/2023]
Abstract
Regularly administering outcome measures to clients to inform clinical decision making, referred to as measurement-based care (MBC), has the potential to improve mental health treatment due to its applicability across disorders and treatment settings. Given the utility of MBC, understanding predictors of high-fidelity MBC implementation is important. Training and consultation are widely used implementation strategies to increase the fidelity of evidence-based practice delivery but have rarely been studied with MBC. The current study will examine the relationship between time clinicians spent discussing a case in consultation ("dosage") and MBC fidelity. Thirty clinicians and 56 youth were in the MBC condition of a randomized controlled trial and completed baseline questionnaires. Consultation dosage was extracted from call notes. MBC fidelity was measured using the implementation index, which combines rates of administering and viewing questionnaires, using objective data from the online MBC system. Multi-level modeling was used. Greater consultation dosage significantly predicted a higher implementation index (ß = 0.27, SE = 0.06, p < .001). For every 30 min spent discussing a case in consultation, the case's MBC fidelity increased by 8.1%. Greater consultation dosage significantly predicted higher rates of administration (ß = 0.07, SE = 0.03, p = 0.033) and feedback report viewing (ß = 0.24, SE = 0.06, p < .001). More consultation at the case level predicts greater MBC fidelity using objective measures. The greatest impact was increasing the clinician feedback report viewing rate. The results of this study can help inform future efforts to increase the fidelity with which MBC is delivered and to make consultation as efficient and effective as possible.
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Affiliation(s)
- Grace S Woodard
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33146, USA.
| | - Elizabeth Casline
- Northwestern University Feinberg School of Medicine, 420 E. Superior Street, Chicago, IL, 60611, USA
| | - Jill Ehrenreich-May
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33146, USA
| | - Golda S Ginsburg
- University of Connecticut School of Medicine, 65 Kane Street Room 3022, West Hartford, CT, 06119, USA
| | - Amanda Jensen-Doss
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33146, USA
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Woodard GS, Mraz A, Renn BN. Perspectives of Nonspecialists Delivering a Brief Depression Treatment in the United States: A Qualitative Investigation. BMC Psychiatry 2023; 23:32. [PMID: 36639746 PMCID: PMC9839228 DOI: 10.1186/s12888-023-04528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Task sharing is an implementation strategy which increases access to services by training and supporting treatment delivery by nonspecialists. Such an approach has demonstrated effectiveness for depression and other mental health outcomes; however, few studies in high-income countries have examined nonspecialist providers' (NSPs) perspectives of the acceptability, feasibility, and appropriateness of delivering mental health interventions. We examine qualitative reports of NSPs experiences delivering a brief structured behavioral intervention for depression (called "Do More, Feel Better" [DMFB]) to adults aged 55 and older. METHODS All NSPs (N = 4, 100%) who delivered DMFB participated in a focus group to probe their perceptions of the acceptability, feasibility, and appropriateness of both the intervention and their delivery experience as NSPs. Two coders analyzed the qualitative data from focus groups using codebook thematic analysis. RESULTS NSPs perceived the intervention and delivery experience to be acceptable, feasible, and appropriate. Qualitative results provided insight into specific barriers and facilitators which may be important to consider when planning to implement task sharing. Themes that emerged from qualitative data included supervision being highly acceptable and feasible, appropriateness of the intervention for NSPs, and the feasibility of tailoring the intervention to patient participants. NSPs also expressed difficulty managing emotional investment in patients' success and providing therapy during a pandemic and racial violence in the US. CONCLUSIONS Our results can inform future implementation and sustainment of task sharing interventions to expand access to care.
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Affiliation(s)
- Grace S. Woodard
- grid.26790.3a0000 0004 1936 8606Department of Psychology, University of Miami, Coral Gables, Florida USA
| | - Amanda Mraz
- grid.272362.00000 0001 0806 6926Department of Psychology, University of Nevada, Las Vegas, 4505 South Maryland Parkway, MS 5030, Las Vegas, Nevada 89154-5030 USA
| | - Brenna N. Renn
- grid.272362.00000 0001 0806 6926Department of Psychology, University of Nevada, Las Vegas, 4505 South Maryland Parkway, MS 5030, Las Vegas, Nevada 89154-5030 USA
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AlRasheed R, Woodard GS, Nguyen J, Daniels A, Park N, Berliner L, Dorsey S. Transitioning to Telehealth for COVID-19 and Beyond: Perspectives of Community Mental Health Clinicians. J Behav Health Serv Res 2022; 49:524-530. [PMID: 35538275 PMCID: PMC9090117 DOI: 10.1007/s11414-022-09799-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/11/2022]
Abstract
In response to COVID-19, mental health clinics transitioned to telehealth to maintain psychotherapy delivery. Community mental health (CMH) settings, which are often under-resourced, likely experienced many barriers. This study examined CMH clinicians’ experiences transitioning to telehealth. Data came from a state-funded initiative training CMH clinicians in cognitive behavioral therapy. Participants (N = 197) completed pre-training and post-consultation surveys which included questions about their experiences with telehealth. Most clinicians found telehealth beneficial and effective. Clinicians strongly endorsed wanting telehealth as an option even after in-person services resume. CMH clinicians rated “engaging younger children” as the most significant barrier to telehealth. Despite some telehealth barriers, clinicians generally viewed telehealth favorably and prefer having it as a long-term option. Future work should continue to understand when telehealth may be advantageous and for whom in order to improve the accessibility and quality of behavioral health services.
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Affiliation(s)
- Rashed AlRasheed
- Department of Psychology, University of Washington, 119A Guthrie Hall, Box 351525, Seattle, WA, 98105, USA.
| | - Grace S Woodard
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - Julie Nguyen
- Department of Psychology, University of Washington, 119A Guthrie Hall, Box 351525, Seattle, WA, 98105, USA
| | - Alayna Daniels
- Department of Psychology, University of Washington, 119A Guthrie Hall, Box 351525, Seattle, WA, 98105, USA
| | - Niya Park
- Department of Psychology, University of Washington, 119A Guthrie Hall, Box 351525, Seattle, WA, 98105, USA
| | - Lucy Berliner
- Harborview Center for Sexual Assault and Traumatic Stress, 401 Broadway, Suite 2027, Seattle, WA, 98122, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, 119A Guthrie Hall, Box 351525, Seattle, WA, 98105, USA
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Woodard GS, Triplett NS, Frank HE, Harrison JP, Robinson S, Dorsey S. The impact of implementation climate on community mental health clinicians’ attitudes toward exposure: An evaluation of the effects of training and consultation. Implementation Research and Practice 2021; 2. [PMID: 36210960 PMCID: PMC9536473 DOI: 10.1177/26334895211057883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Most evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD) and anxiety disorders include exposure; however, in community settings, the implementation of exposure lags behind other EBT components. Clinician-level determinants have been consistently implicated as barriers to exposure implementation, but few organizational determinants have been studied. The current study examines an organization-level determinant, implementation climate, and clinician-level determinants, clinician demographic and background factors, as predictors of attitudes toward exposure and changes in attitudes following training. Method: Clinicians (n = 197) completed a 3-day training with 6 months of twice-monthly consultation. Clinicians were trained in cognitive behavioral therapy (CBT) for anxiety, depression, behavior problems, and trauma-focused CBT (TF-CBT). Demographic and background information, implementation climate, and attitudes toward exposure were assessed in a pre-training survey; attitudes were reassessed at post-consultation. Implementation climate was measured at the aggregated/group-level and clinician-level. Results: Attitudes toward exposure significantly improved from pre-training to post-consultation (t(193) = 9.9, p < .001; d = 0.71). Clinician-level implementation climate scores did not predict more positive attitudes at pre-training (p > .05) but did predict more positive attitudes at post-consultation (ß = −2.46; p < .05) and greater changes in those attitudes (ß = 2.28; p < .05). Group-level implementation climate scores did not predict attitudes at pre-training, post-consultation, or changes in attitudes (all ps > .05). Higher frequency of self-reported CBT use was associated with more positive attitudes at pre-training (ß = −0.81; p < .05), but no other clinician demographic or background determinants were associated with attitudes at post-consultation (all p > .05) or with changes in attitudes (all p > .05). Conclusions: Clinician perceptions of implementation climate predicted greater improvement of attitudes toward exposure following EBT training and consultation. Findings suggest that organizational determinants outside of training impact changes in clinicians’ attitudes. Training in four EBTs, only two of which include exposure as a component, resulted in positive changes in clinicians’ attitudes toward exposure, which suggests non-specialty trainings can be effective at changing attitudes, which may enable scale-up. Exposure is highly effective for treating trauma symptoms and anxiety-based disorders, but it is not commonly used in community mental health settings. Clinicians who endorsed higher expectations, support, and rewards for using exposure in their agency had more positive attitudes toward exposure after training and consultation. Additionally, clinicians who endorsed that exposure is expected, supported, and rewarded in their agency showed a greater improvement in attitudes throughout the training process. Organizational culture can affect clinicians’ attitude changes in the training process, and therefore should become a focus of training efforts.
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Affiliation(s)
- Grace S. Woodard
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Noah S. Triplett
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Hannah E. Frank
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Julie P. Harrison
- Department of Psychiatry, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Sophia Robinson
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
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Woodard GS, Brewer SK, Fuller AK, Lennon Papadakis J, DeCarlo Santiago C. The Effect of Child Gender, Parent School Involvement, and Parent Language Use on School Functioning Among Trauma-Exposed Latinx Youth. Hispanic Journal of Behavioral Sciences 2021. [DOI: 10.1177/07399863211041458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
High rates of trauma exposure can impede school functioning, which is predictive of many negative long-term outcomes. This study examined school functioning in Latinx children with clinically elevated levels of posttraumatic stress symptoms. We found that child gender, parent language use, and parent school involvement were associated with school functioning in complex ways. Interactive effects revealed that the association between parent school involvement and child school functioning depended on parent language use. Greater parent school involvement was linked with better school functioning when parents spoke more English, but parent school involvement did not improve school functioning when parents spoke more Spanish, which may reflect Spanish-speaking parents’ challenges engaging with schools. These findings have important implications for improving academic outcomes for trauma-exposed Latinx youth.
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Affiliation(s)
| | | | | | - Jaclyn Lennon Papadakis
- Northwestern University, Chicago, IL, USA
- Ann & Robert Lurie Children’s Hospital of Chicago, IL, USA
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Meza RD, Triplett NS, Woodard GS, Martin P, Khairuzzaman AN, Jamora G, Dorsey S. The relationship between first-level leadership and inner-context and implementation outcomes in behavioral health: a scoping review. Implement Sci 2021; 16:69. [PMID: 34229706 PMCID: PMC8259113 DOI: 10.1186/s13012-021-01104-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 03/19/2021] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND First-level leadership is uniquely positioned to support evidence-based practice (EBP) implementation for behavioral health due to first-level leaders' access to and relationship with service providers. First-level leaders are individuals who directly supervise and manage frontline employees who do not manage others. However, first-level leadership is underrepresented in existing reviews of the impact of leadership on EBP implementation. This review describes the relationship between first-level leadership and implementation determinants and outcomes. METHODS A scoping review was performed to synthesize the literature on the relationship between first-level leadership and inner-context and implementation outcomes. A literature search was conducted in PubMed, Eric, PsycINFO, CINAHL, Scopus, and Web of Science. To be eligible, studies had to examine first-level leadership, be conducted in settings providing behavioral health services, and examine the relationship between first-level leadership and an implementation or inner-context outcome. Data extraction and synthesis were performed to describe study characteristics, leader-outcome relationships, and overlap in leadership frameworks. RESULTS Twenty-one records met our inclusion criteria. Studies primarily relied on observational designs and were often cross-sectional. Studies more often examined general leadership rather than leadership strategically focused on EBP implementation (i.e., strategic implementation leadership). Our findings suggest that several forms of first-level leadership are inconsistently related to a broad set of implementation determinants, with infrequent examination of specific implementation outcomes. The broad set of implementation determinants studied, limited number of replications, and inconsistent findings have resulted in sparse evidence for any specific leadership-outcome relationship. The greatest accumulation of evidence exists for general leadership's positive relationship with providers' EBP attitudes, most notably in the form of transformational leadership. This was followed by evidence for strategic implementation leadership facilitating general implementation. Our synthesis revealed moderate conceptual overlap of strategic implementation leadership behaviors described in the theory of implementation leadership and theory of middle managers' role in implementation. CONCLUSIONS Our findings suggest that first-level leadership may play an important role in shaping implementation determinants and outcomes, but consistent empirical support is sparse and confidence dampened by methodological issues. To advance the field, we need studies that adopt stronger methodological rigor, address the conceptual overlap in leadership frameworks, examine a broader set of implementation outcomes, and examine conditions under which leadership impacts implementation. TRIAL REGISTRATION This review was not registered.
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Affiliation(s)
- Rosemary D. Meza
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Noah S. Triplett
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Grace S. Woodard
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Prerna Martin
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Alya N. Khairuzzaman
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Gabrielle Jamora
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
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Triplett NS, Woodard GS, AlRasheed R, Meza RD, Robinson S, Berliner L, Dorsey S. Application of Evidence-Based Treatment in Community Mental Health Settings: Examining EBT Delivery Duration and Client Discharge. J Behav Health Serv Res 2021; 48:617-624. [PMID: 33754288 DOI: 10.1007/s11414-021-09755-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2021] [Indexed: 11/24/2022]
Abstract
Characterizing community mental health (CMH) treatment duration and discharge is an important step toward understanding how to better meet client needs. This report describes patterns of treatment duration and discharge among clinicians participating in a state-funded evidence-based treatment (EBT) training initiative. After training and consultation, clinicians (N = 376) reported on treatment duration and discharge for their "most complete case." On average, clinicians delivered 12.4 sessions (SD = 5.1) of the treatment. After completing treatment, half of clinicians (58.7%) continued with regularly scheduled therapy, either using EBT elements or switching to supportive therapy. Clinicians who continued with regularly scheduled therapy delivered treatment in approximately the same number of sessions. Results revealed that CMH clinicians often do not discontinue therapy after completing a treatment protocol. These findings suggest it may be essential to better understand clinician decision-making around applying EBTs to their caseloads.
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Affiliation(s)
- Noah S Triplett
- Department of Psychology, University of Washington, 119A Guthrie Hall, Box 351525, Seattle, WA, 98105, USA.
| | - Grace S Woodard
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - Rashed AlRasheed
- Department of Psychology, University of Washington, 119A Guthrie Hall, Box 351525, Seattle, WA, 98105, USA
| | - Rosemary D Meza
- Department of Psychology, University of Washington, 119A Guthrie Hall, Box 351525, Seattle, WA, 98105, USA
| | - Sophia Robinson
- Department of Psychology, University of Washington, 119A Guthrie Hall, Box 351525, Seattle, WA, 98105, USA
| | - Lucy Berliner
- Harborview Center for Sexual Assault and Traumatic Stress, 401 Broadway, Suite 2027, Seattle, WA, 98122, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, 119A Guthrie Hall, Box 351525, Seattle, WA, 98105, USA
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Woodard GS, Triplett NS, Martin P, Meza RD, Lyon AR, Berliner L, Dorsey S. Implementing Mental Health Services for Children and Adolescents: Caregiver Involvement in School-Based Care. Psychiatr Serv 2020; 71:79-82. [PMID: 31551041 DOI: 10.1176/appi.ps.201900160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study compared clinician contact with clients' caregivers by service setting, specifically schools, which are the most common service setting for youths. METHODS Data were from a state-funded cognitive-behavioral therapy training initiative. Clinicians (N=177) completed pretraining and postconsultation surveys including retrospective reports of caregiver contact and amount of school-based practice. RESULTS School-based clinicians were less likely than non-school-based clinicians to report any contact with caregivers. Full-time school-based clinicians were less likely than part-time school-based clinicians to report any contact with caregivers. School-based clinicians also were less likely than clinicians in other settings to have in-person contact with caregivers, and full-time school-based clinicians were less likely than part-time school-based clinicians to report in-person contact with caregivers. CONCLUSIONS Given the inherent advantages of school-based treatment, integration of mental health services for youths in schools is increasingly supported by funding and policy. The findings of this study suggest, however, that investing in strategies to engage caregivers in such treatment may be worthwhile.
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Affiliation(s)
- Grace S Woodard
- Department of Psychology, University of Washington, Seattle (Woodard, Triplett, Martin, Meza, Dorsey); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Lyon); Harborview Center for Sexual Assault and Traumatic Stress, Seattle (Berliner)
| | - Noah S Triplett
- Department of Psychology, University of Washington, Seattle (Woodard, Triplett, Martin, Meza, Dorsey); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Lyon); Harborview Center for Sexual Assault and Traumatic Stress, Seattle (Berliner)
| | - Prerna Martin
- Department of Psychology, University of Washington, Seattle (Woodard, Triplett, Martin, Meza, Dorsey); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Lyon); Harborview Center for Sexual Assault and Traumatic Stress, Seattle (Berliner)
| | - Rosemary D Meza
- Department of Psychology, University of Washington, Seattle (Woodard, Triplett, Martin, Meza, Dorsey); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Lyon); Harborview Center for Sexual Assault and Traumatic Stress, Seattle (Berliner)
| | - Aaron R Lyon
- Department of Psychology, University of Washington, Seattle (Woodard, Triplett, Martin, Meza, Dorsey); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Lyon); Harborview Center for Sexual Assault and Traumatic Stress, Seattle (Berliner)
| | - Lucy Berliner
- Department of Psychology, University of Washington, Seattle (Woodard, Triplett, Martin, Meza, Dorsey); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Lyon); Harborview Center for Sexual Assault and Traumatic Stress, Seattle (Berliner)
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle (Woodard, Triplett, Martin, Meza, Dorsey); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Lyon); Harborview Center for Sexual Assault and Traumatic Stress, Seattle (Berliner)
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Dorsey S, Meza RD, Martin P, Gray CL, Triplett NS, Soi C, Woodard GS, Lucid L, Amanya C, Wasonga A, Whetten K. Lay Counselor Perspectives of Providing a Child-Focused Mental Health Intervention for Children: Task-Shifting in the Education and Health Sectors in Kenya. Front Psychiatry 2019; 10:860. [PMID: 31920736 PMCID: PMC6928041 DOI: 10.3389/fpsyt.2019.00860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/01/2019] [Indexed: 01/23/2023] Open
Abstract
The global mental health treatment gap has increasingly been addressed using task-shifting; however, very little research has focused on lay counselors' perspectives on the acceptability, feasibility, and appropriateness of mental health interventions in specific government-supported sectors that might scale up and sustain mental health care for children and adolescents. In western Kenya, these sectors include Education and Health. Data come from a large hybrid effectiveness-implementation study examining implementation practices and policies in either or both sectors that support successful implementation of a child-focused intervention, Trauma-focused Cognitive Behavioral Therapy (TF-CBT), for children and adolescents who had experienced parental death. We examined lay counselors' self-report of acceptability, feasibility, and appropriateness of TF-CBT. Lay counselors were teachers (n = 30) from the Education sector and Community Health Volunteers (CHVs; n = 30) from the Health sector, who were part of Sequence 1 of a large stepped-wedge, cluster randomized trial. Lay counselor self-report surveys included reflective and formative measurement of acceptability, feasibility, and appropriateness administered after lay counselors in both sectors had experience delivering the locally-adapted, group-based TF-CBT intervention. Descriptive statistics (means, standard deviations) were used to understand counselors' perspectives stratified by sector. Both teachers and CHVs endorsed high acceptability, feasibility, and appropriateness of TF-CBT, with lay counselors' responses on items from the formative measures providing some insight into specific aspects of acceptability, feasibility, and appropriateness that may be important to consider when planning for implementation support. These early findings suggest that both sectors may hold promise for task-shifting of mental health care for children and adolescents but also underline the importance of considering the multiple facets of these three implementation outcomes as well as lay counselor context (Education vs. Health).
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Affiliation(s)
- Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Rosemary D. Meza
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Prerna Martin
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Christine L. Gray
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Noah S. Triplett
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Caroline Soi
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Grace S. Woodard
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Leah Lucid
- Department of Psychology, University of Washington, Seattle, WA, United States
| | | | | | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States
- Terry Sanford Institute of Public Policy, Duke University, Durham, NC, United States
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Goldstein N, Woodard GS. Surgery for tinea pedis. Syndactylization or amputation of toes for chronic, severe fungus infections. Arch Dermatol 1969; 99:701-4. [PMID: 5783080 DOI: 10.1001/archderm.99.6.701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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