Youth Top Problems in an Acute Psychiatric Sample: Describing Consumer-Nominated Treatment Needs in an Adolescent Partial Hospital Setting

Interactive virtual reality training to improve socio-emotional functioning in adolescents with developmental language disorders: A feasibility study

Methods to effectively improve socio-emotional functioning by adolescents with developmental language disorders (DLD) are scarce. Current methods to improve socio-emotional functioning in adolescents with other neurobiological disorders seem less suitable, as these methods are highly language based. This study therefore examined the feasibility of the virtual reality (VR) training for socio-emotional skills: 'InterAction'. The aims of the present study were to (1) examine whether interactive VR is a feasible training method for adolescents with DLD; (2) investigate adolescents' appreciation of the VR training; (3) examine whether the virtual reality training facilitates the participants' sense of presence during social practice situations in an interactive digital world; and (4) explore whether adolescents socio-emotional skills improved during the six-session training. A sample of nine adolescents (13-16 years) with DLD reported on their presence in VR contexts and their appreciation toward the VR training. They also completed weekly self-reports on their socio-emotional functioning. Results indicated that 'InterAction' was a feasible method to practice socio-emotional functioning with adolescents with DLD. Adolescents highly appreciated the VR training. In addition, adolescents rated the sense of presence as high in the VR training. The individual trajectories showed that improvements in the trained skills varied both between and within participants. The results were also not uniform between the specific skills trained. The findings suggest that interactive virtual reality training may be a promising tool for improving socio-emotional functioning in adolescents with DLD. Future studies should examine the positive indications of this study in a larger sample.

Measurement-based care in an adolescent partial hospitalization program: Exploring treatment progress and predictors using the top problems assessment

This study used measurement-based care (MBC) to examine patient improvement and trajectories of change during treatment in an adolescent partial hospitalization program (PHP). The current study also explored whether youth trajectories in PHP varied based on demographic variables, symptom severity at intake, or presence of an anxiety or depressive disorder diagnosis. Participants included 124 youth (aged 13-18) with primarily anxiety and depression diagnoses who received care in a PHP. The Top Problems Assessment (TPA), an idiographic measure of patients' chief complaints, was administered weekly alongside depression and anxiety symptom questionnaires to incorporate the consumer perspective. Results demonstrated that youth significantly benefitted from PHP treatment across all measures. The rate of TPA improvement slowed down over time whereas the rates of decline for the anxiety and depression questionnaires did not change statistically. Anxiety disorder status and more severe baseline anxiety symptoms were also independently associated with slower rates of improvement on TPA, but not on the symptom measures. Overall, these results suggest youth improved from treatment in this PHP, and that changes in youth-reported top problems may be more prominent at the beginning of treatment. Moreover, providers may want to consider treatment modifications, or perhaps monitor progress more closely, for youth who present with higher anxiety severity at PHP admission. This study demonstrates how incorporating MBC practices and personalized assessment in a PHP can enable exploration of who benefits most, under what conditions, and when.

A Pilot Project to Integrate Individualized Measurement Into Measurement-Based Care in a Child Partial Hospitalization Program

Measurement-based care (MBC), or the regular use of progress measures to inform clinical decision-making, improves quality of care and clinical outcomes. MBC typically focuses on standardized rather than individualized outcome measurement. In this pilot study, we examined the clinical utility of integrating individualized measurement with existing standardized outcome monitoring in a children's partial hospitalization program. Participants were 48 youth (M age 10.13 ± 1.39; 54.2% male, 41.7% female, 4.2% transgender or nonbinary). Comorbidity was common; 83.4% of youth had more than one diagnosis at intake. Using the Youth Top Problems for individualized outcome measurement, we examined Top Problem content and clinical improvement over time. Finally, we examined completion rates and describe implementation issues. Top Problems were heterogeneous and sensitive to change. Of the 144 problems, 107 (74%) had a focus consistent with measures used in program, while 37 (26%) were not captured by standardized measures used in program. Effect sizes from admission to final measurement ranged from Cohen's d = .75 - 1.00. Initial adoption of the MBC was strong, but sustained use of the system over the treatment course was challenging. Individualized outcome measurement in children's partial hospitalization programs is feasible to administer and sensitive to clinical change that is unique from change captured in standardized measures. Parents were able to self-identify clinically meaningful, highly individualized Top Problems. Challenges of implementation and clinical assessment in acute settings and potential strategies for improving implementation are discussed.