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Chiu AW, Desai P, Skriner L, Catarozoli C, Sullivan P, Bennett SM. Youth Top Problems in an Acute Psychiatric Sample: Describing Consumer-Nominated Treatment Needs in an Adolescent Partial Hospital Setting. Child Psychiatry Hum Dev 2024; 55:520-530. [PMID: 36074210 DOI: 10.1007/s10578-022-01427-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Accepted: 08/27/2022] [Indexed: 11/28/2022]
Abstract
Given the wide range of diagnostic presentations treated in partial hospital programs, finding efficient ways to identify and measure progress on the chief concerns of consumers in these settings is important. The current study uses a self-administered version of the Top Problems Assessment to describe treatment targets identified by youth and their caregivers presenting for care at an adolescent partial hospital setting. Caregiver-youth agreement on these chief concerns upon admission and predictors of agreement were explored. About one-third (34.65%) of caregiver-youth pairs did not match on any target problems. Although anxiety and depression were the most commonly cited top problems in this sample, caregivers and youth exhibited disagreement on these domains. Treatment teams in acute care settings such as a partial hospital program can benefit from careful assessment surrounding the initial goals of treatment as youth and their caregivers may not agree on the referral problems upon entering a program.
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Affiliation(s)
- Angela W Chiu
- Department of Child and Adolescent Psychiatry, Weill Cornell Medicine-New York-Presbyterian Hospital, 315 East 62nd Street, 5th floor, New York, NY, 10065, USA.
| | - Payal Desai
- Department of Child and Adolescent Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Laura Skriner
- The Center for Stress, Anxiety, and Mood, Summit, NJ, USA
| | - Corinne Catarozoli
- Department of Child and Adolescent Psychiatry, Weill Cornell Medicine-New York-Presbyterian Hospital, 315 East 62nd Street, 5th floor, New York, NY, 10065, USA
| | - Paul Sullivan
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine/NYC Health + Hospitals/Bellevue, New York, NY, USA
| | - Shannon M Bennett
- Department of Child and Adolescent Psychiatry, Weill Cornell Medicine-New York-Presbyterian Hospital, 315 East 62nd Street, 5th floor, New York, NY, 10065, USA
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2
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Schriger SH, Becker-Haimes EM, Skriner L, Beidas RS. Clinical Supervision in Community Mental Health: Characterizing Supervision as Usual and Exploring Predictors of Supervision Content and Process. Community Ment Health J 2021; 57:552-566. [PMID: 32671507 PMCID: PMC7855099 DOI: 10.1007/s10597-020-00681-w] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 07/04/2020] [Indexed: 11/27/2022]
Abstract
Clinical supervision can be leveraged to support implementation of evidence-based practices in community mental health settings, though it has been understudied. This study focuses on 32 supervisors at 23 mental health organizations in Philadelphia. We describe characteristics of supervisors and organizations and explore predictors of supervision content and process. Results highlight a low focus on evidence-based content and low use of active supervision processes. They underscore the need for further attention to the community mental health context when designing supervision-targeted implementation strategies. Future work should assess whether supervision models specific to community mental health are needed.
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Affiliation(s)
- Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily M Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Room 3015, Philadelphia, PA, 19104, USA.,Hall-Mercer Community Mental Health Center, Philadelphia, PA, USA
| | - Laura Skriner
- Evidence-Based Practitioners of New Jersey, Summit, NJ, USA
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Room 3015, Philadelphia, PA, 19104, 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, Philadelphia, PA, USA. .,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Adams DR, Williams NJ, Becker-Haimes EM, Skriner L, Shaffer L, DeWitt K, Neimark G, Jones DT, Beidas RS. Therapist Financial Strain and Turnover: Interactions with System-Level Implementation of Evidence-Based Practices. Adm Policy Ment Health 2020; 46:713-723. [PMID: 31203492 DOI: 10.1007/s10488-019-00949-8] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Therapist turnover is a major problem in community mental health. Financial strain, which is composed of cognitive, emotional, and behavioral responses to the experience of economic hardship, is an understudied antecedent of therapist turnover given the tumultuous financial environment in community mental health. We prospectively examined the relationship between therapist financial strain and turnover in 247 therapists in 28 community mental health agencies. We expected greater therapist financial strain to predict higher turnover and participation in a system-funded evidence-based practice (EBP) training initiative to alleviate this effect. Controlling for covariates, financial strain predicted therapist turnover (OR 1.12, p = .045), but not for therapists who participated in an EBP training initiative. Reducing financial strain and/or promoting EBP implementation may be levers to reduce turnover.
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Affiliation(s)
- Danielle R Adams
- School of Social Service Administration, University of Chicago, Chicago, IL, USA.,Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA
| | | | - Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA.,Hall-Mercer Community Mental Health Center, Philadelphia, PA, USA
| | - Laura Skriner
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA.,Evidence-Based Practitioners of New Jersey, Summit, NJ, USA
| | - Lauren Shaffer
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA.,University of Texas, Southwestern, TX, Dallas, USA
| | - Kathryn DeWitt
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA.,Qualtrics, Provo, UT, USA
| | | | | | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, 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, Philadelphia, PA, USA.
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Beidas RS, Becker-Haimes EM, Adams DR, Skriner L, Stewart RE, Wolk CB, Buttenheim AM, Williams NJ, Inacker P, Richey E, Marcus SC. Feasibility and acceptability of two incentive-based implementation strategies for mental health therapists implementing cognitive-behavioral therapy: a pilot study to inform a randomized controlled trial. Implement Sci 2017; 12:148. [PMID: 29246236 PMCID: PMC5732393 DOI: 10.1186/s13012-017-0684-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 06/13/2017] [Accepted: 11/27/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Informed by our prior work indicating that therapists do not feel recognized or rewarded for implementation of evidence-based practices, we tested the feasibility and acceptability of two incentive-based implementation strategies that seek to improve therapist adherence to cognitive-behavioral therapy for youth, an evidence-based practice. METHODS This study was conducted over 6 weeks in two community mental health agencies with therapists (n = 11) and leaders (n = 4). Therapists were randomized to receive either a financial or social incentive if they achieved a predetermined criterion on adherence to cognitive-behavioral therapy. In the first intervention period (block 1; 2 weeks), therapists received the reward they were initially randomized to if they achieved criterion. In the second intervention period (block 2; 2 weeks), therapists received both rewards if they achieved criterion. Therapists recorded 41 sessions across 15 unique clients over the project period. Primary outcomes included feasibility and acceptability. Feasibility was assessed quantitatively. Fifteen semi-structured interviews were conducted with therapists and leaders to assess acceptability. Difference in therapist adherence by condition was examined as an exploratory outcome. Adherence ratings were ascertained using an established and validated observational coding system of cognitive-behavioral therapy. RESULTS Both implementation strategies were feasible and acceptable-however, modifications to study design for the larger trial will be necessary based on participant feedback. With respect to our exploratory analysis, we found a trend suggesting the financial reward may have had a more robust effect on therapist adherence than the social reward. CONCLUSIONS Incentive-based implementation strategies can be feasibly administered in community mental health agencies with good acceptability, although iterative pilot work is essential. Larger, fully powered trials are needed to compare the effectiveness of implementation strategies to incentivize and enhance therapists' adherence to evidence-based practices such as cognitive-behavioral therapy.
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Affiliation(s)
- Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA.
| | - Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
| | - Danielle R Adams
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
- School of Social Service Administration, University of Chicago, Chicago, USA
| | - Laura Skriner
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
- New York-Presbyterian Hospital, Weill Cornell School of Medicine, New York, USA
| | - Rebecca E Stewart
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
| | - Courtney Benjamin Wolk
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
| | - Alison M Buttenheim
- School of Nursing, University of Pennsylvania, Philadelphia, USA
- The Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, USA
| | | | | | | | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, USA
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Beidas R, Skriner L, Adams D, Wolk CB, Stewart RE, Becker-Haimes E, Williams N, Maddox B, Rubin R, Weaver S, Evans A, Mandell D, Marcus SC. The relationship between consumer, clinician, and organizational characteristics and use of evidence-based and non-evidence-based therapy strategies in a public mental health system. Behav Res Ther 2017; 99:1-10. [PMID: 28865284 DOI: 10.1016/j.brat.2017.08.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/15/2017] [Accepted: 08/21/2017] [Indexed: 11/30/2022]
Abstract
We investigated the relationship between consumer, clinician, and organizational factors and clinician use of therapy strategies within a system-wide effort to increase the use of cognitive-behavioral therapy. Data from 247 clinicians in 28 child-serving organizations were collected. Clinicians participating in evidence-based practice training initiatives were more likely to report using cognitive-behavioral therapy when they endorsed more clinical experience, being salaried clinicians, and more openness to evidence-based practice. Clinicians participating in evidence-based practice initiatives were more likely to use psychodynamic techniques when they had older clients, less knowledge about evidence-based practice, more divergent attitudes toward EBP, higher financial strain, and worked in larger organizations. In clinicians not participating in evidence-based training initiatives; depersonalization was associated with higher use of cognitive-behavioral; whereas clinicians with less knowledge of evidence-based practices were more likely to use psychodynamic techniques. This study suggests that clinician characteristics are important when implementing evidence-based practices; and that consumer, clinician, and organizational characteristics are important when de-implementing non evidence-based practices. This work posits potential characteristics at multiple levels to target with implementation and deimplementation strategies.
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Affiliation(s)
- Rinad Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA.
| | - Laura Skriner
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA; Department of Psychiatry, Weill Cornell Medicine, New York-Presbyterian Hospital, 21 Bloomingdale Road, White Plains, NY 10605, USA.
| | - Danielle Adams
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA; School of Social Service Administration, The University of Chicago, 969 East 60th Street, Chicago, IL 60637, USA.
| | - Courtney Benjamin Wolk
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA.
| | - Rebecca E Stewart
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA.
| | - Emily Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA.
| | - Nathaniel Williams
- School of Social Work, Boise State University, 1910 University Drive, Boise, ID 83642, USA.
| | - Brenna Maddox
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA.
| | - Ronnie Rubin
- Department of Behavioral Health and Intellectual DisAbility Services, 801 Market St #7000, Philadelphia, PA 19107, USA.
| | - Shawna Weaver
- Department of Behavioral Health and Intellectual DisAbility Services, 801 Market St #7000, Philadelphia, PA 19107, USA.
| | - Arthur Evans
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA; Department of Behavioral Health and Intellectual DisAbility Services, 801 Market St #7000, Philadelphia, PA 19107, USA.
| | - David Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA.
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, USA.
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Beidas RS, Adams DR, Kratz HE, Jackson K, Berkowitz S, Zinny A, Cliggitt LP, DeWitt KL, Skriner L, Evans A. Lessons learned while building a trauma-informed public behavioral health system in the City of Philadelphia. Eval Program Plann 2016; 59:21-32. [PMID: 27501466 PMCID: PMC5048572 DOI: 10.1016/j.evalprogplan.2016.07.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 07/14/2016] [Indexed: 05/20/2023]
Abstract
Exposure to traumatic experiences among youth is a serious public health concern. A trauma-informed public behavioral health system that emphasizes core principles such as understanding trauma, promoting safety, supporting consumer autonomy, sharing power, and ensuring cultural competence, is needed to support traumatized youth and the providers who work with them. This article describes a case study of the creation and evaluation of a trauma-informed publicly funded behavioral health system for children and adolescents in the City of Philadelphia (the Philadelphia Alliance for Child Trauma Services; PACTS) using the Exploration, Preparation, Implementation, and Sustainment (EPIS) as a guiding framework. We describe our evaluation of this effort with an emphasis on implementation determinants and outcomes. Implementation determinants include inner context factors, specifically therapist knowledge and attitudes (N=114) towards evidence-based practices. Implementation outcomes include rate of PTSD diagnoses in agencies over time, number of youth receiving TF-CBT over time, and penetration (i.e., number of youth receiving TF-CBT divided by the number of youth screening positive on trauma screening). We describe lessons learned from our experiences building a trauma-informed public behavioral health system in the hopes that this case study can guide other similar efforts.
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Affiliation(s)
- Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA.
| | - Danielle R Adams
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA
| | - Hilary E Kratz
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA
| | - Kamilah Jackson
- Community Behavioral Health, 801 Market Street, Philadelphia, PA 19107, USA, USA
| | - Steven Berkowitz
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA
| | - Arturo Zinny
- Community Behavioral Health, 801 Market Street, Philadelphia, PA 19107, USA, USA
| | - Lauren Pilar Cliggitt
- Hall Mercer, Community Mental Health Center, 245 South 8th Street, Philadelphia, PA 19106, USA
| | - Kathryn L DeWitt
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA
| | - Laura Skriner
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA
| | - Arthur Evans
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA; Department of Behavioral Health and Intellectual disAbility Services, 1101 Market Street, Philadelphia, PA 19107, USA
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