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Gettinger M, Kratochwill TR, Levin JR, Eubanks A, Foy A. Academic and behavior combined support: A single-case practice-based replication study. J Sch Psychol 2024; 104:101307. [PMID: 38871416 DOI: 10.1016/j.jsp.2024.101307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 08/09/2022] [Accepted: 03/04/2024] [Indexed: 06/15/2024]
Abstract
The purpose of this research was to conduct a practice-based replication of Academic and Behavior Combined Support (ABC Support), a previously developed and experimentally evaluated supplemental intervention that merges a combined focus on reading fluency and academic engagement. In the present study, a school-based interventionist and data collector had access to implementation resources online and participated in virtual training and coaching. Four Grade 2 students received the ABC Support intervention for 6 weeks in their school. Students' oral fluency on training and non-training reading passages, as well as occurrence of engagement and disruptive behaviors during universal reading instruction, were measured repeatedly across baseline, intervention, and follow-up phases in a multiple-baseline design. In concert with prior empirical findings on ABC Support, analyses revealed improvement from baseline to intervention for both reading and behavior outcomes, as well as from baseline to follow-up assessments. Empirical contributions of the study are offered within the context of replication research and an implementation science perspective. We also emphasize the importance of telecommunication for practice-based research evaluation of interventions.
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Affiliation(s)
- Maribeth Gettinger
- Wisconsin Center for Education Research, University of Wisconsin-Madison, Madison, WI 53705, USA.
| | - Thomas R Kratochwill
- Wisconsin Center for Education Research, University of Wisconsin-Madison, Madison, WI 53705, USA
| | | | - Abigail Eubanks
- Wisconsin Center for Education Research, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Alison Foy
- Wisconsin Center for Education Research, University of Wisconsin-Madison, Madison, WI 53705, USA
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2
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Violante S, McLeod BD, Southam-Gerow MA, Chorpita BF, Weisz JR. Using Adherence and Competence Measures Based on Practice Elements to Evaluate Treatment Fidelity for Two CBT Programs for Youth Anxiety. Behav Ther 2024; 55:605-620. [PMID: 38670672 PMCID: PMC11055981 DOI: 10.1016/j.beth.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 04/28/2024]
Abstract
Measures designed to assess the quantity and quality of practices found across treatment programs for specific youth emotional or behavioral problems may be a good fit for evaluating treatment fidelity in effectiveness and implementation research. Treatment fidelity measures must demonstrate certain reliability and validity characteristics to realize this potential. This study examines the extent to which two observational measures, the Cognitive-Behavioral Treatment for Anxiety in Youth Adherence Scale (CBAY-A) and the CBAY Competence Scale (CBAY-C), can assess the quantity (the degree to which prescribed therapeutic techniques are delivered as intended) or quality (the competence with which prescribed techniques are delivered) of practices found in two distinct treatment programs for youth anxiety. Treatment sessions (N = 796) from 55 youth participants (M age = 9.89 years, SD = 1.71; 46% female; 55% White) with primary anxiety problems who participated in an effectiveness study were independently coded by raters who coded quantity, quality, and the youth-clinician alliance. Youth received one of three treatments: (a) standard (i.e., cognitive-behavioral therapy program), (b) modular (i.e., a cognitive-behavioral and parent-training program), and (c) usual clinical care. Interrater reliability for the CBAY-A items was good across the standard and modular conditions but mixed for the CBAY-C items. Across the standard and modular conditions, the CBAY-A Model subscale scores demonstrated evidence of construct validity, but the CBAY-C Model subscale scores showed mixed evidence. The results provide preliminary evidence that the CBAY-A can be used across different treatment programs but raise concerns about the generalizability of the CBAY-C.
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3
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Patel-Syed Z, Becker S, Olson M, Rinella H, Scott K. What do you think it means? Using cognitive interviewing to improve measurement in implementation science: description and case example. Implement Sci Commun 2024; 5:14. [PMID: 38355677 PMCID: PMC10865651 DOI: 10.1186/s43058-024-00549-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Pragmatic measures are essential to evaluate the implementation of evidence-based interventions. Cognitive interviewing, a qualitative method that collects partner feedback throughout measure development, is particularly useful for developing pragmatic implementation measures. Measure developers can use cognitive interviewing to increase a measure's fit within a particular implementation context. However, cognitive interviewing is underused in implementation research, where most measures remain "homegrown" and used for single studies. We provide a rationale for using cognitive interviewing in implementation science studies and illustrate its use through a case example employing cognitive interviewing to inform development of a measurement-based care protocol for implementation in opioid treatment programs. Applications of cognitive interviewing, including developing a common language with partners and collecting multi-level feedback on assessment procedures, to improve measurement in implementation science are discussed.
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Affiliation(s)
- Zabin Patel-Syed
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Dissemination and Implementation Science, Chicago, USA.
| | - Sara Becker
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Dissemination and Implementation Science, Chicago, USA
| | - Miranda Olson
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Dissemination and Implementation Science, Chicago, USA
| | - Hailey Rinella
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Dissemination and Implementation Science, Chicago, USA
| | - Kelli Scott
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Dissemination and Implementation Science, Chicago, USA
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Agudelo-Hernández F, Rojas-Andrade R. Design and validation of a scale of core components of community interventions in mental health. Int J Health Plann Manage 2024; 39:36-47. [PMID: 37796724 DOI: 10.1002/hpm.3711] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/22/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023] Open
Abstract
AIMS To develop and validate an instrument to identify the core components of community strategies for mental health, especially mutual aid groups: The Mutual Aid Scale . METHODS 135 community strategies leaders participated in the study. The core components are active agency, coping strategies, recognition, and management of emotions, problem-solving strategies, supportive interaction, trust, self-identity construction, and strengthening of social networks. With these components a scale was designed. Content validity was carried out in addition to an exploratory factor analysis. RESULTS Two dimensions resulted, strengthening of agency capacity and Coping strategies, and the internal consistency of both factors was acceptable, with a Cronbach's alpha of 0.722 and 0.727, respectively. The Kaiser-Meyer-Olkin (KMO) statistic was used with a score of 0.831 and the Barlett Sphericity Test, with a significant value of 265.175. CONCLUSION This scale identifies the components of community interventions for mental health and can contribute to a better implementation of these strategies. It also articulates autonomous community processes with strategies developed in health services.
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Papola D, Karyotaki E, Purgato M, Sijbrandij M, Tedeschi F, Cuijpers P, Orestis E, Furukawa TA, Patel V, Barbui C. Dismantling and personalising task-sharing psychosocial interventions for common mental disorders: a study protocol for an individual participant data component network meta-analysis. BMJ Open 2023; 13:e077037. [PMID: 37918937 PMCID: PMC10626809 DOI: 10.1136/bmjopen-2023-077037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Common mental disorders, including depression, anxiety and related somatic health symptoms, are leading causes of disability worldwide. Especially in low-resource settings, psychosocial interventions delivered by non-specialist providers through task-sharing modalities proved to be valid options to expand access to mental healthcare. However, such interventions are usually eclectic multicomponent interventions consisting of different combinations of evidence-based therapeutic strategies. Which of these various components (or combinations thereof) are more efficacious (and for whom) to reduce common mental disorder symptomatology is yet to be substantiated by evidence. METHODS AND ANALYSIS Comprehensive search was performed in electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Register of Controlled Trials-CENTRAL from database inception to 15 March 2023 to systematically identify all randomised controlled trials that compared any single component or multicomponent psychosocial intervention delivered through the task-sharing modality against any active or inactive control condition in the treatment of adults suffering from common mental disorders. From these trials, individual participant data (IPD) of all measured outcomes and covariates will be collected. We will dismantle psychosocial interventions creating a taxonomy of components and then apply the IPD component network meta-analysis (IPD-cNMA) methodology to assess the efficacy of individual components (or combinations thereof) according to participant-level prognostic factors and effect modifiers. ETHICS AND DISSEMINATION Ethics approval is not applicable for this study since no original data will be collected. Results from this study will be published in peer-reviewed journals and presented at relevant conferences.
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Affiliation(s)
- Davide Papola
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Efthimiou Orestis
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
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Lin Y, Zhang X, Zhou T, Xu F, Zhu X, Zhou H, Wang X, Ding Y. Identifying the common elements of psychological and psychosocial interventions for preventing postpartum depression: Application of the distillation and matching model to 37 winning protocols from 36 intervention studies. Early Interv Psychiatry 2023; 17:947-962. [PMID: 37680169 DOI: 10.1111/eip.13462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/16/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
AIM Postpartum depression is prevalent worldwide and seriously endangers maternal and child health. Previous studies have demonstrated the effectiveness of psychological and psychosocial intervention programmes in preventing postpartum depression. However, the literature offers limited practice guidance. Therefore, this study aimed to deeply analyse prior findings to gather rich evidence-based information on this topic. METHODS Using the distillation and matching model, we conducted a systematic review of psychological and psychosocial interventions used to effectively prevent postpartum depression. Four researchers trained in coding system independently read eligible studies and identified reliable (Cohen's kappa >0.40) and frequently occurring (frequency ≥3 winning study groups) practice elements. RESULTS Our review included 36 studies containing 37 winning study groups. Fourteen practice elements were identified and subsequently divided into six categories: postpartum practical problems-related, social support-related, interpersonal psychotherapy-related, cognitive behavioural therapy-related, labour trauma-related and non-specific techniques. The most common practice elements were baby care skills and mother-infant bonding/interaction enhancement. Inter-rater reliability averaged 0.86, ranging from 0.48 to 1. CONCLUSION The practice elements identified in this study provide rich evidence-based information that can guide clinical practitioners in selecting or developing effective, realistically available intervention programmes.
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Affiliation(s)
- Yuping Lin
- School of Nursing, Fudan University, Shanghai, China
- Nursing Department, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | | | - Tianchun Zhou
- School of Nursing, Fudan University, Shanghai, China
- Nursing Department, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Feng Xu
- Nursing Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Xinli Zhu
- Department of Obstetrics, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Huixin Zhou
- Department of Obstetrics, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Xiao Wang
- Department of Obstetrics, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Yan Ding
- Nursing Department, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
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Cohen ZD, Barnes-Horowitz NM, Forbes CN, Craske MG. Measuring the active elements of cognitive-behavioral therapies. Behav Res Ther 2023; 167:104364. [PMID: 37429044 DOI: 10.1016/j.brat.2023.104364] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 06/09/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
Understanding how and for whom cognitive-behavioral therapies work is central to the development and improvement of mental health interventions. Suboptimal quantification of the active elements of cognitive-behavioral therapies has hampered progress in elucidating mechanisms of change. To advance process research on cognitive-behavioral therapies, we describe a theoretical measurement framework that focuses on the delivery, receipt, and application of the active elements of these interventions. We then provide recommendations for measuring the active elements of cognitive-behavioral therapies aligned with this framework. Finally, to support measurement harmonization and improve study comparability, we propose the development of a publicly available repository of assessment tools: the Active Elements of Cognitive-Behavioral Therapies Measurement Kit.
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Affiliation(s)
- Zachary D Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States.
| | | | - Courtney N Forbes
- Department of Psychology, University of California, Los Angeles, United States
| | - Michelle G Craske
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States; Department of Psychology, University of California, Los Angeles, United States
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8
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Ackermann RT, Cameron KA, Liss DT, Dolan N, Aikman C, Carson A, Harris SA, Doyle K, Cooper AJ, Hitsman B. Primary care delivery of behavioral weight loss services for adults with cardiovascular risk factors: development of pragmatic practice components and results of a randomized feasibility trial. RESEARCH SQUARE 2023:rs.3.rs-3074046. [PMID: 37547026 PMCID: PMC10402202 DOI: 10.21203/rs.3.rs-3074046/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Background Intensive lifestyle interventions (ILI) improve weight loss and cardiovascular risk factors, but health systems face challenges implementing them. We engaged stakeholders to cocreate and evaluate feasibility of primary care implementation strategies and of a pragmatic randomization procedure to be used for a future effectiveness trial. Methods The study setting was a single, urban primary care office. Patients with BMI ≥ 27 and ≥ 1 cardiovascular risk factor were sent a single electronic health record (EHR) message between December 2019 and January 2020 offering services to support an initial weight loss goal of about 10 pounds in 10 weeks. All patients who affirmed weight loss interest were pragmatically enrolled in the trial and offered "Basic Lifestyle Services" (BLS), including a scale that transmits weight data to the EHR using cellular networks, a coupon to enroll in lifestyle coaching resources through a partnering fitness organization, and periodic EHR messages encouraging use of these resources. About half (n = 42) of participants were randomized by an automated EHR algorithm to also receive "Customized Lifestyle Services" (CLS), including weekly email messages adapted to individual weight loss progress and telephonic coaching by a nurse for those facing challenges. Interventions and assessments spanned January to July 2020, with interference by the coronavirus pandemic. Weight measures were collected from administrative sources. Qualitative analysis of stakeholder recommendations and patient interviews assessed acceptability, appropriateness, and sustainability of intervention components. Results Over 6 weeks, 426 patients were sent the EHR invitation message and 80 (18.8%) affirmed interest in the weight loss goal and were included for analysis. EHR data were available to ascertain a 6-month weight value for 77 (96%) patients. Overall, 62% of participants lost weight; 15.0% exhibited weight loss ≥ 5%, with no statistically significant difference between CLS or BLS arms (p = 0.85). CLS assignment increased participation in daily self-weighing (43% versus 21% of patients through 12 weeks) and enrollment in referral-based lifestyle support resources (52% versus 37%). Conclusions This preliminary study demonstrates feasibility of implementation strategies for primary care offices to offer and coordinate ILI core components, as well as a pragmatic randomization procedure for use in a future randomized comparative trial.
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9
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Ackermann RT, Cameron K, Liss D, Dolan N, Aikman C, Carson A, Harris S, Doyle K, Cooper A, Hitsman B. Primary care delivery of behavioral weight loss services for adults with cardiovascular risk factors: development of pragmatic implementation strategies and results of a randomized feasibility trial. RESEARCH SQUARE 2023:rs.3.rs-2806196. [PMID: 37292808 PMCID: PMC10246232 DOI: 10.21203/rs.3.rs-2806196/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Intensive lifestyle interventions (ILI) improve weight loss and cardiovascular risk factors, but health systems face challenges implementing them. We engaged stakeholders to cocreate and evaluate feasibility of primary care implementation strategies and of a pragmatic randomization procedure to be used for a future effectiveness trial. Methods The study setting was a single, urban primary care office. Patients with BMI ≥ 27 and ≥ 1 cardiovascular risk factor were sent a single electronic health record (EHR) message between December 2019 and January 2020 offering services to support an initial weight loss goal of about "10 pounds in 10 weeks." All patients who affirmed weight loss interest were pragmatically enrolled in the trial and offered "Basic Lifestyle Services" (BLS), including a scale that transmits weight data to the EHR using cellular networks, a coupon to enroll in lifestyle coaching resources through a partnering fitness organization, and periodic EHR messages encouraging use of these resources. About half (n = 42) of participants were randomized by an automated EHR algorithm to also receive "Customized Lifestyle Services" (CLS), including weekly email messages adapted to individual weight loss progress and telephonic coaching by a nurse for those facing challenges. Interventions and assessments spanned January to July 2020, with interference by the coronavirus pandemic. Weight measures were collected from administrative sources. Qualitative analysis of stakeholder recommendations and patient interviews assessed acceptability, appropriateness, and sustainability of intervention components. Results Over 6 weeks, 426 patients were sent the EHR invitation message and 80 (18.8%) affirmed interest in the weight loss goal and were included for analysis. EHR data were available to ascertain a 6-month weight value for 77 (96%) patients. Overall, 62% of participants lost weight; 15.0% exhibited weight loss ≥ 5%, with no statistically significant difference between CLS or BLS arms (p = 0.85). CLS assignment increased participation in daily self-weighing (43% versus 21% of patients through 12 weeks) and enrollment in referral-based lifestyle support resources (52% versus 37%). Conclusions This preliminary study demonstrates feasibility of implementation strategies for primary care offices to offer and coordinate ILI core components, as well as a pragmatic randomization procedure for use in a future randomized comparative trial.
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Affiliation(s)
| | | | - David Liss
- Northwestern University Feinberg School of Medicine
| | - Nancy Dolan
- Northwestern University Feinberg School of Medicine
| | | | | | | | - Kathryn Doyle
- Northwestern Medicine: Northwestern Memorial HealthCare Corp
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Engell T, Stadnick NA, Aarons GA, Barnett ML. Common Elements Approaches to Implementation Research and Practice: Methods and Integration with Intervention Science. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2023; 3:1-15. [PMID: 37013068 PMCID: PMC10063479 DOI: 10.1007/s43477-023-00077-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/05/2023] [Indexed: 04/03/2023]
Abstract
We propose that common elements approaches can advance implementation research and practice and facilitate pragmatic use of intervention and implementation evidence. Common elements are practices or processes frequently shared by interventions or implementations. Traditional common elements methodologies use synthesis, distillation, and statistics to describe and evaluate the merit of common ingredients in effective interventions. Recent developments include identifying and testing common configurations of elements, processes, and context variables across the literature of effective interventions and implementations. While common elements thinking has grown popular in intervention science, it has rarely been utilized in implementation science, and specifically, combined with the intervention literature. The goals of this conceptual methodology paper are to (1) provide an overview of the common elements concept and how it may advance implementation research and usability for practice, (2) give a step-by-step guide to systematic common elements reviews that synthesizes and distills the intervention and implementation literature together, and (3) offer recommendations for advancing element-level evidence in implementation science. A narrative review of the common elements literature was conducted with attention to applications to implementation research. A six-step guide to using an advanced common elements methodology was provided. Examples of potential results are presented, along with a review of the implications for implementation research and practice. Finally, we reviewed methodological limitations in current common elements approaches, and identified steps towards realizing their potential. Common elements methodologies can (a) synthesize and distill the implementation science literature into practical applications, (b) generate evidence-informed hypotheses about key elements and determinants in implementation and intervention processes and mechanisms, and (c) promote evidence-informed precision tailoring of intervention and implementation to context. To realize this potential, common elements approaches need improved reporting of details from both successful and unsuccessful intervention and implementation research, more data availability, and more testing and investigation of causal processes and mechanisms of change from diverse theories. Supplementary Information The online version contains supplementary material available at 10.1007/s43477-023-00077-4.
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Affiliation(s)
- Thomas Engell
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaugveien 1-3, 0484 Oslo, Norway
| | - Nicole A. Stadnick
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093 USA
- Child and Adolescent Services Research Center, San Diego, CA 92123 USA
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA 92093 USA
| | - Gregory A. Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093 USA
- Child and Adolescent Services Research Center, San Diego, CA 92123 USA
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA 92093 USA
| | - Miya L. Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, CA 93106-9490 USA
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11
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Whitfield J, Owens S, Bhat A, Felker B, Jewell T, Chwastiak L. Successful ingredients of effective Collaborative Care programs in low- and middle-income countries: A rapid review. Glob Ment Health (Camb) 2023; 10:e11. [PMID: 37854388 PMCID: PMC10579696 DOI: 10.1017/gmh.2022.60] [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: 08/11/2022] [Revised: 11/01/2022] [Accepted: 11/22/2022] [Indexed: 03/19/2023] Open
Abstract
Integrating mental health care in primary healthcare settings is a compelling strategy to address the mental health treatment gap in low- and middle-income countries (LMICs). Collaborative Care is the integrated care model with the most evidence supporting its effectiveness, but most research has been conducted in high-income countries. Efforts to implement this complex multi-component model at scale in LMICs will be enhanced by understanding the model components that have been effective in LMIC settings. Following Cochrane Rapid Reviews Methods Group recommendations, we conducted a rapid review to identify studies of the effectiveness of Collaborative Care for priority adult mental disorders of mhGAP (mood and anxiety disorders, psychosis, substance use disorders and epilepsy) in outpatient medical settings in LMICs. Article screening and data extraction were performed using Covidence software. Data extraction by two authors utilized a checklist of key components of effective interventions. Information was aggregated to examine how frequently the components were applied. Our search yielded 25 articles describing 20 Collaborative Care models that treated depression, anxiety, schizophrenia, alcohol use disorder or epilepsy in nine different LMICs. Fourteen of these models demonstrated statistically significantly improved clinical outcomes compared to comparison groups. Successful models shared key structural and process-of-care elements: a multi-disciplinary care team with structured communication; standardized protocols for evidence-based treatments; systematic identification of mental disorders, and a stepped-care approach to treatment intensification. There was substantial heterogeneity across studies with respect to the specifics of model components, and clear evidence of the importance of tailoring the model to the local context. This review provides evidence that Collaborative Care is effective across a range of mental disorders in LMICs. More work is needed to demonstrate population-level and longer-term outcomes, and to identify strategies that will support successful and sustained implementation in routine clinical settings.
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Affiliation(s)
- Jessica Whitfield
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
| | - Shanise Owens
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Bradford Felker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Teresa Jewell
- University of Washington Health Sciences Library, University of Washington, Seattle, WA, USA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA
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Sengupta S, Marx L, Hilt R, Martini DR, DeMaso DR, Beheshti N, Borcherding B, Butler A, Fallucco E, Fletcher K, Homan E, Lai K, Pierce K, Sharma A, Earls M, Rockhill C, Bukstein OG, Abright AR, Becker T, Diamond J, Hayek M, Keable H, Vasa RA, Walter HJ. Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care. J Am Acad Child Adolesc Psychiatry 2023; 62:91-119. [PMID: 35779696 DOI: 10.1016/j.jaac.2022.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this Clinical Update is to review the principles, structures, processes, and outcomes of collaborative mental health care in the pediatric primary care setting. METHOD A search of the literature on this topic from 2001was conducted initially in 2016, yielding 2,279 English-language citations. These citations were supplemented by references suggested by topic experts and identified through Web searches, increasing the yield to 2,467 total citations, of which 1,962 were unduplicated. After sequential review by Update authors at title/abstract and then full-text levels, the citations were winnowed to 219 based on topic relevance. A follow-up search from 2016 was conducted in 2021, yielding 2 additional citations based on nonduplication from initial search and topic relevance. RESULTS The collaborative care approach, arising in the 1990s and gaining momentum in the 2000s, aims to extend behavioral health care to the primary care setting. The goal of collaborative care is to conserve the sparse specialty care workforce for severe and complex psychiatric disorders through shifting certain specialty mental health tasks (eg, assessment; patient self-management; brief psychosocial intervention; basic psychopharmacology; care coordination) to primary care. Collaborative care can be delivered on a spectrum ranging from coordinated to co-located to integrated care. Although each of these models has some empirical support, integrated care-a multidisciplinary team-based approach-has the strongest evidence base in improving clinical outcomes and patient satisfaction while constraining costs. Challenges to integrated care implementation include insufficient mental health education and insufficient specialist consultative and care coordination support for primary care practitioners; space, time, and reimbursement constraints in the primary care setting; discomfort among primary care practitioners in assuming mental health tasks previously undertaken by specialists; and continuing need for and unavailability of ongoing specialty mental health care for severe and complex cases. Essential supporting activities for effective collaborative care include patient and family engagement, professional education and training, evaluation/demonstration of impact, fiscal sustainability, and advocacy for model dissemination. CONCLUSION Health professionals who are educated in the collaborative care approach can improve access to and quality of behavioral health care for children and adolescents with behavioral health needs.
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Bunn M, Zolman N, Smith CP, Khanna D, Hanneke R, Betancourt TS, Weine S. Family-based mental health interventions for refugees across the migration continuum: A systematic review. SSM - MENTAL HEALTH 2022. [PMID: 37529116 PMCID: PMC10392776 DOI: 10.1016/j.ssmmh.2022.100153] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study reviewed the literature on family-based mental health interventions for refugees across migration contexts and settings to identify types of interventions and intervention components, implementation approaches and to assess effectiveness. The review used a systematic approach, and ten intervention studies were retained for analysis. The findings identified three primary types of family-based mental health interventions used with diverse refugee communities in settings in the Global North and South-parenting groups, multiple family groups and home visiting interventions. Findings indicated that non-specialized or peer providers were frequently utilized to deliver the interventions though additional details on the workforce and workforce development strategies are needed to better understand how to sustain and support such providers. The findings suggest that family-based mental health interventions are potentially effective for improving a range of child and caregiver mental health outcomes and improving family processes and functioning among refugee families. However, the empirical evidence is quite limited to date, with a need for additional rigorous studies, especially with refugee families in humanitarian settings, to further build the evidence base.
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Ssewamala FM, McKay MM, Sensoy Bahar O, Nabunya P, Neilands T, Kiyingi J, Namatovu P, Guo S, Nakasujja N, Mwebembezi A. Suubi4StrongerFamilies: A study protocol for a clustered randomized clinical trial addressing child behavioral health by strengthening financial stability and parenting among families in Uganda. Front Psychiatry 2022; 13:949156. [PMID: 36506418 PMCID: PMC9726732 DOI: 10.3389/fpsyt.2022.949156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Children in Sub-Saharan Africa are burdened by significant unmet mental health needs. Across the region, high rates of poverty, HIV/AIDS, food insecurity, stigma, and an inadequate health safety net system exacerbate serious child behavioral health needs and impede an effective response. Disruptive behavioral disorders are particularly concerning as they persist through adolescence and adulthood. Hence, addressing the context-specific social influences on child behavioral health is critical given that children in the region comprise more than half of the total regional population. Against this backdrop, this study protocol describes a randomized clinical trial that will examine the mechanisms by which economic empowerment and family strengthening interventions targeting social, familial, and context-specific drivers affect the mental health of children in Uganda. Methods The study uses an experimental, longitudinal design across 30 cluster-randomized primary schools to compare single and combination intervention options; influences of economic empowerment and family strengthening on economic, perceptual, and functioning mediators; and context-specific moderators. The study will be conducted with 900 Ugandan children in mid-upper primary school (10-14 years). The three study conditions (n = 300 each) are: (1) economic empowerment only (EE only), (2) multiple family group-based family strengthening only (MFG-based FS only), and (3) combined EE + MFG-based FS. The interventions will be provided for 12 months; and assessments will occur at baseline, 12, 24, and 36 months. Conclusion Children in Sub-Saharan Africa are burdened by significant unmet mental health needs, including disruptive behavior disorders that persist through adolescence and adulthood if left untreated. The proposed study will examine the mechanisms by which economic empowerment and family strengthening interventions targeting social, familial and context-specific drivers affect the mental health of children in mid-upper primary schools in Uganda. Findings from this study can inform group, community, and population approaches that are needed for scalable solutions to address the social drivers negatively impacting child behavioral health in low-resource settings, including in Sub-Saharan Africa. Clinical trial registration [https://clinicaltrials.gov/], identifier [NCT053 68714].
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Affiliation(s)
- Fred M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Mary M. McKay
- Vice Provost Office, Washington University in St. Louis, St. Louis, MO, United States
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Torsten Neilands
- School of Medicine, University of California, San Francisco, San Francisco, LA, United States
| | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Phionah Namatovu
- International Center for Child Health and Development Field Office, Masaka, Uganda
| | - Shenyang Guo
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
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15
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Santisteban DA, Mena MP, McCabe BE, Abalo C, Puccinelli M. Comparing individually based and family-based treatments for internalizing, externalizing, and family symptoms in Latino youth. FAMILY PROCESS 2022; 61:1144-1161. [PMID: 35437789 DOI: 10.1111/famp.12776] [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] [Received: 03/23/2021] [Revised: 01/16/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
Rigorous randomized trials that test promising culturally centered treatments for Latino youth and families are needed. This study adds to the knowledge base by comparing the efficacy of Culturally Informed and Flexible Family Treatment for Adolescents (CIFFTA) to an Individually Oriented Treatment-As-Usual (ITAU) in its ability to retain Latino youth and families in treatment, reduce internalizing and externalizing child symptoms, and improve family functioning. CIFFTA uses an adaptive/flexible approach to deliver individual therapy, family therapy, and psycho-educational modules tailored to each family's unique clinical and cultural characteristics. Two hundred Latino adolescents 11-14 years of age completed a baseline assessment, were randomly assigned to CIFFTA or ITAU, then were assessed again after 16 weeks of intervention. Results show that CIFFTA had significantly higher retention (83%) than ITAU (71%), OR = 2.05, p = .036. Youth in both conditions showed significant reductions in youth and parent reported externalizing and internalizing behaviors, and there were no differences in change between conditions. Parents in CIFFTA reported significantly greater reductions in family conflict, d = 0.38, p = .025 than in ITAU. In CIFFTA, children of less acculturated Latino parents showed more improvement than the children of more acculturated parents. In ITAU, the reverse was true, children of more acculturated parents reported more improvement. This evidence of CIFFTA's impact on retention, family conflict, and differential effect depending on cultural values and behaviors, has important implications for the field of Latino psychology and family treatment.
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Affiliation(s)
| | - Maite P Mena
- Department of Educational and Psychological Studies, School of Education and Human Development, University of Miami, Coral Gables, Florida, USA
| | - Brian E McCabe
- Department of Special Education, Rehabilitation, and Counseling (SERC), Auburn University, Auburn, Alabama, USA
| | | | - Marc Puccinelli
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
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Morgan NR, Davenport KE, Aronson KR, McCarthy KJ, Bleser JA, Perkins DF. The Relationship between Veterans’ Employment Program Component Use and Career Advancement Over Time. JOURNAL OF VETERANS STUDIES 2022. [DOI: 10.21061/jvs.v8i1.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Perkins DF, Davenport KE, Morgan NR, Aronson KR, Bleser JA, McCarthy KJ, Vogt D, Finley EP, Copeland LA, Gilman CL. The influence of employment program components upon job attainment during a time of identity and career transition. INTERNATIONAL JOURNAL FOR EDUCATIONAL AND VOCATIONAL GUIDANCE 2022; 23:1-23. [PMID: 35194475 PMCID: PMC8853002 DOI: 10.1007/s10775-022-09527-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
This study assessed the effectiveness of employment programs components, which resulted in the identification of content and process components that increase employability. Employment program use was studied among 1172 United States of America military veterans to determine which content (i.e., interviewing skills) and process (i.e., working with a mentor/coach) components influence job attainment during a time of career and identity transition. Components were distilled utilizing a common components analysis approach (Morgan et al., 2018). Associations with finding employment up to 15 months after the military-to-civilian transition were explored. Veterans who engaged with employment programs were primarily accessing the following components: career planning, resume writing, and interviewing skills. However, only a few content components were significantly related to obtaining employment: interviewing (with mentor/coach), resume writing (online tools), translating military to civilian work (with mentor/coach), entrepreneurship (with mentor/coach), and virtual career fairs. Furthermore, not all processes or modes of instruction for content components were associated with success in the job market. Having a mentor/coach was one of the most effective delivery strategies. For example, veterans using programs delivered by a mentor/coach that translated military skills to civilian work were more likely to find a job at 6-9-months (84%) and 12-15-months (91%) post military separation. In addition, risks that predicted lower use of employment program components by veterans were identified such as junior enlisted rank, combat exposure, combat arms occupation, and physical health problems. With these findings, program developers, implementers, and funders can channel efforts towards the utilization of employment programs with effective components.
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Affiliation(s)
- Daniel F. Perkins
- Clearinghouse for Military Family Readiness, Pennsylvania State University (Clearinghouse), University Park, PA USA
- Social Science Research Institute, Pennsylvania State University, University Park, PA USA
- Department of Agricultural Economics, Sociology and Education, Pennsylvania State University, University Park, PA USA
| | - Katie E. Davenport
- Clearinghouse for Military Family Readiness, Pennsylvania State University (Clearinghouse), University Park, PA USA
| | - Nicole R. Morgan
- Clearinghouse for Military Family Readiness, Pennsylvania State University (Clearinghouse), University Park, PA USA
| | - Keith R. Aronson
- Clearinghouse for Military Family Readiness, Pennsylvania State University (Clearinghouse), University Park, PA USA
- Social Science Research Institute, Pennsylvania State University, University Park, PA USA
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA USA
| | - Julia A. Bleser
- Clearinghouse for Military Family Readiness, Pennsylvania State University (Clearinghouse), University Park, PA USA
| | - Kimberly J. McCarthy
- Clearinghouse for Military Family Readiness, Pennsylvania State University (Clearinghouse), University Park, PA USA
| | - Dawne Vogt
- National Center for PTSD at VA Boston Health Care System, Boston, MA USA
- Boston University, Boston, MA USA
| | - Erin P. Finley
- University of Texas Health Science Center at San Antonio, San Antonio, TX USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Laurel A. Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, MA USA
- University of Massachusetts Medical School, Worcester, MA USA
| | - Cynthia L. Gilman
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
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In Search of the Common Elements of Clinical Supervision: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:623-643. [PMID: 35129739 DOI: 10.1007/s10488-022-01188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 10/19/2022]
Abstract
The importance of clinical supervision for supporting effective implementation of evidence-based treatments (EBTs) is widely accepted; however, very little is known about which supervision practice elements contribute to implementation effectiveness. This systematic review aimed to generate a taxonomy of empirically-supported supervision practice elements that have been used in treatment trials and shown to independently predict improved EBT implementation. Supervision practice elements were identified using a two-phase, empirically-validated distillation process. In Phase I, a systematic review identified supervision protocols that had evidence of effectiveness based on (a) inclusion in one or more EBT trials, and (b) independent association with improved EBT implementation in one or more secondary studies. In Phase II, a hybrid deductive-inductive coding process was applied to the supervision protocols to characterize the nature and frequency of supervision practice elements across EBTs. Twenty-one of the 876 identified articles assessed the associations of supervision protocols with implementation or clinical outcomes, representing 13 separate studies. Coding and distillation of the supervision protocols resulted in a taxonomy of 21 supervision practice elements. The most frequently used elements were: reviewing supervisees' practice (92%; n = 12), clinical suggestions (85%; n = 11), behavioral rehearsal (77%; n = 10), elicitation (77%; n = 10), and fidelity assessment (77%; n = 10). This review identified supervision practice elements that could be targets for future research testing which elements are necessary and sufficient to support effective EBT implementation. Discrepancies between supervision practice elements observed in trials as compared to routine practice highlights the importance of research addressing supervision-focused implementation strategies.
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The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) in Portugal: Feasibility Study Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031782. [PMID: 35162806 PMCID: PMC8835210 DOI: 10.3390/ijerph19031782] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/23/2022] [Accepted: 01/29/2022] [Indexed: 01/27/2023]
Abstract
The Unified Protocol for Children (UP-C) is a transdiagnostic Cognitive-Behavioral Therapy group intervention for children and caregivers targeting the treatment of children’s emotional disorders (EDs). The present study aims to assess the feasibility and acceptability of the UP-C in the Portuguese population using a single-armed design. The participants were 32 children (6–12 years of age) with an ED (anxiety and/or depressive disorder) as a main diagnosis and their parents. All participants received the UP-C intervention and were assessed at pretreatment, midtreatment, posttreatment, and 3 months posttreatment. Children, parents, the clinicians, and an external observer completed questionnaires to assess the feasibility and acceptability of the UP-C (e.g., satisfaction, motivation, and adherence). Children and parents also completed self-report measures assessing the children’s anxiety and depression and its interference and severity. The results of the present study support the feasibility and acceptability of the UP-C in Portugal; low dropout rates, high adherence rates, and high levels of child and parent satisfaction and motivation were observed. Moreover, significant reductions over time in children’s levels of anxiety and/or depression and of its interference and severity were found and were maintained after 3 months of follow-up. These results are promising and warrant a subsequent randomized controlled trial (RCT).
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20
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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: 1] [Impact Index Per Article: 0.3] [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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Gettinger M, Kratochwill TR, Eubanks A, Foy A, Levin JR. Academic and Behavior Combined Support: Evaluation of an integrated supplemental intervention for early elementary students. J Sch Psychol 2021; 89:1-19. [PMID: 34836573 DOI: 10.1016/j.jsp.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/16/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
In current multi-tier models, students who are not responsive to universal instruction receive supplementary support. Despite most students having co-occurring academic and behavior challenges, their needs are often addressed through separate academic or behavior interventions. This approach may not only be costly for schools, but it also fails to acknowledge the well-documented link between behavior and academic performance. The purpose of this study was to evaluate Academic and Behavior Combined Support (ABC Support), a newly developed supplemental intervention that merges a combined focus on reading fluency and engagement. Six teachers implemented the intervention for 6-8 weeks with Grade 2 students. Students' oral fluency on standard and training reading passages and occurrence of engagement and disruptive behaviors during classroom reading instruction were measured repeatedly across baseline and intervention phases in a multiple-baseline design. Visual and statistical analyses revealed significant improvement from baseline to intervention for both reading and behavior outcomes. Post-intervention surveys and interviews revealed a high level of acceptability among teachers and students. Theoretical and empirical contributions as well as practice implications are addressed.
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Affiliation(s)
- Maribeth Gettinger
- Wisconsin Center for Education Research, University of Wisconsin-Madison, USA.
| | | | - Abigail Eubanks
- Wisconsin Center for Education Research, University of Wisconsin-Madison, USA
| | - Alison Foy
- Wisconsin Center for Education Research, University of Wisconsin-Madison, USA
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22
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Olson JR, Benjamin PH, Azman AA, Kellogg MA, Pullmann MD, Suter JC, Bruns EJ. Systematic Review and Meta-analysis: Effectiveness of Wraparound Care Coordination for Children and Adolescents. J Am Acad Child Adolesc Psychiatry 2021; 60:1353-1366. [PMID: 33785404 DOI: 10.1016/j.jaac.2021.02.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/22/2021] [Accepted: 02/19/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Wraparound is a common method for coordinating care for children and adolescents with serious emotional disorders (SED), with nearly 100,000 youths served annually in the United States. The current systematic review and meta-analysis estimated effects on youth outcomes (symptoms, functioning, school, juvenile justice, and residential placement) and costs. METHOD A literature search identified 17 peer-reviewed and gray literature studies meeting criteria, which were coded on characteristics of sample, design, implementation, and outcomes. Random effects modeling was conducted using Comprehensive Meta-Analysis Version 3.0. Effect sizes were calculated using Hedges g. Homogeneity of effects were assessed using Q statistics. RESULTS Medium-sized effects favored Wraparound-enrolled youths for costs (g = 0.391, CI = 0.282-0.500, p < .001), residential outcomes (g = 0.413, CI = 0.176-0.650, p = .001), and school functioning (g = 0.397, CI = 0.106-0.688, p = .007); small effects were found for mental health symptoms (g = 0.358, CI = 0.030-0.687, p = .033) and functioning (g = 0.315, CI = 0.086-0.545, p = .007). Larger effects were found for peer-reviewed studies, quasi-experimental designs, samples with a larger percentage of youths of color, and Wraparound conditions with higher fidelity. CONCLUSION Results indicate positive effects for Wraparound, especially for maintaining youths with SED in the home and community. However, many studies showed methodological weaknesses, and fidelity measurement was largely absent, suggesting a need for additional research. Nonetheless, the results should aid decisions around resource allocation, referral practices, and system partnerships among child psychiatrists and other behavioral health professionals.
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Affiliation(s)
- Jonathan R Olson
- Drs. Olson, Pullmann, Bruns, Mr. Benjamin, and Mss. Azman and Kellogg are with the University of Washington School of Medicine, Seattle.
| | - Philip H Benjamin
- Drs. Olson, Pullmann, Bruns, Mr. Benjamin, and Mss. Azman and Kellogg are with the University of Washington School of Medicine, Seattle
| | - Alya A Azman
- Drs. Olson, Pullmann, Bruns, Mr. Benjamin, and Mss. Azman and Kellogg are with the University of Washington School of Medicine, Seattle
| | - Marianne A Kellogg
- Drs. Olson, Pullmann, Bruns, Mr. Benjamin, and Mss. Azman and Kellogg are with the University of Washington School of Medicine, Seattle
| | - Michael D Pullmann
- Drs. Olson, Pullmann, Bruns, Mr. Benjamin, and Mss. Azman and Kellogg are with the University of Washington School of Medicine, Seattle
| | - Jesse C Suter
- Dr. Suter is with the Center on Disability and Community Inclusion, University of Vermont, Burlington
| | - Eric J Bruns
- Drs. Olson, Pullmann, Bruns, Mr. Benjamin, and Mss. Azman and Kellogg are with the University of Washington School of Medicine, Seattle
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Aggarwal S, Patton G, Berk M, Patel V. Psychosocial interventions for self-harm in low-income and middle-income countries: systematic review and theory of change. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1729-1750. [PMID: 33394070 PMCID: PMC7611648 DOI: 10.1007/s00127-020-02005-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To synthesise the evidence on effectiveness, acceptability and the delivery mechanisms of psychosocial interventions for self-harm in low and middle income countries and to develop a pathway of change specific for self-harm interventions. METHOD Studies reporting one or more patient or implementation outcomes of a psychosocial intervention targeting self-harm and conducted in low- and middle-income countries were included. Taxonomy of treatment components and a theory of change map was created using information from the studies. RESULTS We identified thirteen studies including nine randomised controlled trials (RCT), three non-RCTs, and a single experimental case design study. A single study using postcard contact and another using cognitive behaviour therapy (CBT) reported a reduction in self-harm attempts. Suicidal ideations were significantly reduced with CBT, volitional help sheets and postcard contact in different studies. Suicide risk assessment, problem solving and self-validation were the most frequently used elements in interventions. Goal-setting was the technique used most commonly. Cultural adaptations of psychotherapies were used in two studies. High attrition rates in psychotherapy trials, limited benefit of the delivery of treatment by non-specialist providers, and variable benefit observed using phone contact as a means to deliver intervention were other important findings. CONCLUSION There were no strong positive findings to draw definitive conclusions. Limited availability and evidence for culturally adapted interventions in self-harm, lack of evaluation of task sharing using evidence based interventions as well as a dearth in evaluation and reporting of various intervention delivery models in low- and middle-income countries were major literature gaps.
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Affiliation(s)
- Shilpa Aggarwal
- Public Health Foundation of India (Centre for Chronic Conditions), New Delhi, India. .,Faculty of Health, School of Medicine, Deakin University, Geelong, Australia.
| | - George Patton
- Murdoch Children’s Research Institute (Centre for Adolescent Health), Victoria, Australia
| | - Michael Berk
- IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia,Department of Psychiatry, Orygen (Centre for Youth Mental Health), Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Vikram Patel
- Harvard T H Chan School of Public Health, Global Health and Social Medicine, Boston, MA, USA
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Hogue A, Bobek M, Porter N, Dauber S, Southam-Gerow MA, McLeod BD, Henderson CE. Core Elements of Family Therapy for Adolescent Behavioral Health Problems: Validity Generalization in Community Settings. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021:1-13. [PMID: 34519608 PMCID: PMC8918434 DOI: 10.1080/15374416.2021.1969939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The core elements of family therapy for adolescent mental health and substance use problems, originally distilled from high-fidelity sessions conducted by expert clinicians, were tested for validity generalization when delivered by community therapists in routine settings. METHOD The study sampled recorded sessions from 161 cases participating in one of three treatment pools: implementation trial of Functional Family Therapy (98 sessions/50 cases/22 therapists), adaptation trial of Multisystemic Therapy (115 sessions/59 cases/2 therapists), and naturalistic trial of non-manualized family therapy in usual care (107 sessions/52 cases/21 therapists). Adolescents were identified as 60% male and 40% female with an average age of 15.4 years; 49% were Latinx, 27% White Non-Latinx, 15% African American, 3% another race/ethnicity, 6% race/ethnicity unknown. Session recordings (n = 320) were randomly selected for each case and coded for 21 discrete family therapy techniques. Archived data of one-year clinical outcomes were gathered. RESULTS Confirmatory factor analyses replicated the factor structure from the original distillation study, retaining all four clinically coherent treatment modules comprised of all 21 techniques: Interactional Change (ICC = .77, Cronbach's α = .81); Relational Reframe (ICC = .75, α = .81); Adolescent Engagement (ICC = .72, α = .78); Relational Emphasis (ICC = .76, α = .80). Exploratory analyses found that greater use of core techniques predicted symptom improvements in one treatment pool. CONCLUSIONS Core techniques of family therapy distilled from manualized treatments for adolescent behavioral health problems showed strong evidence of validity generalization, and initial evidence of links to client outcomes, in community settings.
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Affiliation(s)
- Aaron Hogue
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction
| | - Molly Bobek
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction
| | - Nicole Porter
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction
| | - Sarah Dauber
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction
| | | | - Bryce D McLeod
- Department of Psychology, Virginia Commonwealth University
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25
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Lidchi V, Wiener A. How can services be improved to effectively address the mental health of vulnerable children and young people? CHILD ABUSE & NEGLECT 2021; 119:104648. [PMID: 32928564 DOI: 10.1016/j.chiabu.2020.104648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 07/11/2020] [Accepted: 07/25/2020] [Indexed: 06/11/2023]
Abstract
This discussion article describes a Child and Adolescent Mental Health Service (CAMHS) in the United Kingdom developed to meet the mental health needs of children and young people particularly those vulnerable children and young people at risk of actual or potential harm through child abuse and neglect, but may not be therapy ready. The aim was to improve the level of access to CAMHS for vulnerable groups and the quality and effectiveness of services for children, young people and their families.The model of service delivery is underpinned by the THRIVE Framework for System Change (THRIVE) which builds on the resilience of families and the skills of the workers who have the closest relationships with them. The article describes how a redesign was accomplished in the London Borough of Camden between 2016- 2018 to do this. Qualitative evidence of the positive impact of the changes for service users and key workers and quantitative evidence of the increased service capacity are presented. Challenges and opportunities provided by the new service model are discussed.
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Affiliation(s)
- Victoria Lidchi
- Tavistock and Portman NHS Foundation Trust, London, United Kingdom.
| | - Andy Wiener
- Tavistock and Portman NHS Foundation Trust, London, United Kingdom
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26
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Barwick M, Barac R, Kimber M, Akrong L, Johnson SN, Cunningham CE, Bennett K, Ashbourne G, Godden T. Advancing implementation frameworks with a mixed methods case study in child behavioral health. Transl Behav Med 2021; 10:685-704. [PMID: 30698775 PMCID: PMC7413184 DOI: 10.1093/tbm/ibz005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Despite a growing policy push for the provision of services based on evidence, evidence-based treatments for children and youth with mental health challenges have poor uptake, yielding limited benefit. With a view to improving implementation in child behavioral health, we investigated a complementary implementation approach informed by three implementation frameworks in the context of implementing motivational interviewing in four child and youth behavioral health agencies: the Active Implementation Frameworks (AIF) (process), the Consolidated Framework for Implementation Research (factors), and the Implementation Outcomes Framework (evaluation). The study design was mixed methods with embedded interrupted time series and motivational interviewing (MI) fidelity was the primary outcome. Focus groups and field notes informed perspectives on the implementation approach, and a questionnaire explored the salience of Consolidated Framework for Implementation Research (CFIR) factors. Findings validate the process guidance provided by the AIF and highlight CIFR factors related to implementation success. Novel CFIR factors, not elsewhere reported in the literature, are identified that could potentially extend the framework if validated in future research. Introducing fidelity measurement in practice proved challenging and was not sustained beyond the study. A complementary implementation approach was successful in implementing MI in child behavioral health agencies. In contrast with the typical train and hope approach to implementation, practice change did not occur immediately post-training but emerged over a 7 month period of consultation and practice following a discrete interactive training period. The saliency of CFIR constructs aligned with findings from studies conducted in other contexts, demonstrating external validity and highlighting common factors that can focus planning and measurement.
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Affiliation(s)
- Melanie Barwick
- Research Institute, The Hospital for Sick Children, Toronto, Canada.,Department of Psychiatry, University of Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Canada
| | - Raluca Barac
- Memorial University, St John's, Newfoundland, Canada
| | - Melissa Kimber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Lindsay Akrong
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | | | - Charles E Cunningham
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.,McMaster Children's Hospital, Hamilton, Canada
| | - Kathryn Bennett
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | | | - Tim Godden
- Centre for Addiction and Mental Health, Toronto, Canada
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27
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Bruns EJ, Benjamin PH, Shepler RN, Kellogg M, Pluckebaum H, Woolston JL, English K, Zabel MD. Manuscript: Defining Quality Standards for Intensive Home Based Treatment Programs for Youth with Serious Emotional Disorders. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:1065-1088. [PMID: 34241737 PMCID: PMC8267760 DOI: 10.1007/s10488-021-01116-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Abstract
Intensive Home Based Treatment (IHBT) is a critical component of the continuum of community-based behavioral healthcare for youth with serious emotional disorder (SED) and their families. Yet despite being used nationwide at costs of over $100 million annually in some states, a well-vetted, research-based set of quality standards for IHBT has yet to be developed. The current project aimed to define program and practice standards for IHBT, drawing upon literature review, expert interviews, and a systematic Delphi process engaging over 80 participants, including IHBT developers, experts in evidence-based youth mental health, youth and family advocates, IHBT providers, and state policymakers. After two rounds of quantitative and qualitative input, adequate consensus was achieved on 32 IHBT Program Standards and 43 IHBT Practice Standards. These standards hold potential for informing efforts such as development of state regulations, provider contracts, memoranda of agreement, and training and workforce development initiatives. Translation of the quality standards into measurement strategies holds potential for providing a method of continuous quality improvement across multiple levels as well as use in research on IBHT.
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Affiliation(s)
- Eric J Bruns
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Building 29, Suite 110, Seattle, WA, 98115, USA.
| | - Philip H Benjamin
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Building 29, Suite 110, Seattle, WA, 98115, USA
| | - Richard N Shepler
- Center for Innovative Practices, Case Western Reserve University, 11402 Bellflower Road, Cleveland, OH, 44106, USA
| | - Marianne Kellogg
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Building 29, Suite 110, Seattle, WA, 98115, USA
| | - Hunter Pluckebaum
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Building 29, Suite 110, Seattle, WA, 98115, USA
| | - Joseph L Woolston
- Yale University School of Medicine, Child Study Center, 230 South Frontage Road, New Haven, CT, 06519-1124, USA
| | - Kelly English
- Children's Behavioral Health Knowledge Center, Massachusetts Department of Mental Health, 25 Staniford Street, Boston, MA, 02114, USA
| | - Michelle D Zabel
- School of Social Work, University of Maryland, 306 W. Redwood Street, 2nd Floor, Baltimore, MD, 21202, USA
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Knowledge of Evidence-Based Services Questionnaire: Development and Validation of a Short Form. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:581-596. [PMID: 32076887 DOI: 10.1007/s10488-020-01020-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Knowledge of Evidence-Based Services Questionnaire (KEBSQ) is an objective measure of therapist knowledge of practices derived from the evidence base for the treatment of youth psychopathology. However, the length of this measure (i.e., 40 items) and respondent demands associated with each item makes it burdensome for researchers and clinicians. This study developed and validated a Short Form of the KEBSQ using Item Response Theory measurement models. The Short Form consists of 17 items and generates two separate scores: Correct Endorsements and Correct Rejections. The Short Form was found to correlate highly with and perform similarly to the Full Form, providing preliminary validity evidence.
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Cruz CM, Lamb MM, Giri P, Vanderburg J, Ferrarone P, Bhattarai S, Giardina AA, Hampanda K, Gaynes BN, Matergia M. Perceptions, attitudes, and knowledge of teachers serving as mental health lay counselors in a low and middle income country: a mixed methods pragmatic pilot study. Int J Ment Health Syst 2021; 15:40. [PMID: 33926487 PMCID: PMC8082764 DOI: 10.1186/s13033-021-00453-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Low and middle-income countries (LMICs) lack trained child mental health professionals. While teachers’ child development experience potentially positions them to fill the gap as lay mental health counselors, they have rarely delivered indicated child mental health care in LMICs. As part of assessing the feasibility of teachers serving as lay counselors, we explored teachers’ perceptions of serving as lay counselors and their mental health attitudes and knowledge. Methods In 2018, with training and supervision, 19 primary school teachers from five rural, low cost private schools in Darjeeling, India, served as lay counselors in their classrooms. Using mixed methods, we examined teacher perceptions of serving as lay counselor and mental health attitudes and knowledge through a survey (n = 15), a summative assessment (n = 14), and semi-structured interviews (n = 17). For the survey and summative assessment, pre-training, post-training, and post-intervention mean scores were compared using paired t tests. Post-intervention interviews were coded for teachers’ perceptions of serving as lay counselor and mental health attitudes and knowledge. Results Qualitatively, teachers expressed being willing to serve as lay counselor, having more inclusive mental health attitudes, and retaining mental health knowledge as applicable to use during instructional time or incorporation into the knowledge transfer process, their primary duty. By contrast, quantitatively, teachers’ attitudes appeared to become more inclusive on the study-specific survey pre versus post-training, but reverted to pre-training levels post-intervention. Teachers’ mental health knowledge on the summative assessment did not change pre-training versus post-training versus post-intervention. Conclusions Training, supervision, and serving as lay counselors led to teachers’ willingness to serve as lay counselors. Teachers served as lay counselors by utilizing therapeutic techniques during class time and incorporating them into their typical instruction, not through delivering traditional office-like care. Teacher practices may be pointing to the potential emergence of an “education as mental health therapy” system of care. Their changes in attitudes and knowledge reflected their emerging practices. Quantitative measures of knowledge and attitude changes did not capture these nuanced changes. Trial Registration The parent feasibility trial was registered on January 01, 2018 with Clinical Trials Registry – India (CTRI), reg. no. CTRI/2018/01/011471, ref. no. REF/2017/11/015895. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=21129&EncHid=&modid=&compid=%27,%2721129det%27.. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-021-00453-3.
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Affiliation(s)
- Christina M Cruz
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Drive, CB #7160, Chapel Hill, NC, 27599, USA.
| | - Molly M Lamb
- Department of Epidemiology, Colorado School of Public Health at the University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop C245, Aurora, 80045, CO, USA.,Center for Global Health, Colorado School of Public Health at the University of Colorado Anschutz Medical Campus, 131999 E. Montview Blvd., Suite 310, Mail Box A090, Aurora, CO, 80045, USA
| | - Priscilla Giri
- Darjeeling Ladenla Road Prerna, 42 Ladenla Road, Darjeeling, West Bengal, 734101, India
| | - Juliana Vanderburg
- School Psychology Program, University of North Carolina at Chapel Hill School of Education, 100 E. Cameron Ave, Chapel Hill, NC, 27514, USA
| | - Peter Ferrarone
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Surekha Bhattarai
- Darjeeling Ladenla Road Prerna, 42 Ladenla Road, Darjeeling, West Bengal, 734101, India
| | - Aileen A Giardina
- Broadleaf Health and Education Alliance, 919 Main Street, Stroudsburg, PA, 18360, USA
| | - Karen Hampanda
- Center for Global Health, Colorado School of Public Health at the University of Colorado Anschutz Medical Campus, 131999 E. Montview Blvd., Suite 310, Mail Box A090, Aurora, CO, 80045, USA.,Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Drive, CB #7160, Chapel Hill, NC, 27599, USA
| | - Michael Matergia
- Center for Global Health, Colorado School of Public Health at the University of Colorado Anschutz Medical Campus, 131999 E. Montview Blvd., Suite 310, Mail Box A090, Aurora, CO, 80045, USA. .,Broadleaf Health and Education Alliance, 919 Main Street, Stroudsburg, PA, 18360, USA.
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30
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Bradley WJ, Becker KD. Clinical Supervision of Mental Health Services: A Systematic Review of Supervision Characteristics and Practices Associated with Formative and Restorative Outcomes. CLINICAL SUPERVISOR 2021; 40:88-111. [PMID: 34045790 DOI: 10.1080/07325223.2021.1904312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this review, the authors examined supervision characteristics and practices associated with formative (e.g., skill development) and restorative (e.g., well-being) provider outcomes. We used qualitative review to summarize supervision characteristics associated with desired outcomes. Then, we applied a distillation approach (Chorpita et al., 2005) to identify practices associated with formative and restorative outcomes. The most common practices for promoting formative outcomes were corrective feedback, discussing intervention, and role play. Findings indicate several supervision strategies have demonstrated empirical support for improving formative outcomes. However, more rigorous research is needed in community settings, particularly for understanding which strategies improve restorative outcomes.
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31
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Discovering Common Elements of Empirically Supported Self-Help Interventions for Depression in Primary Care: a Systematic Review. J Gen Intern Med 2021; 36:869-880. [PMID: 33564943 PMCID: PMC8042082 DOI: 10.1007/s11606-020-06449-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although the efficacy of self-help cognitive-behavioral therapy (CBT) for depression has been well established, its feasibility in primary care settings is limited because of time and resource constraints. The goal of this study was to identify common elements of empirically supported (i.e., proven effective in controlled research) self-help CBTs and frameworks for effective use in practice. METHODS Randomized controlled trials (RCTs) for self-help CBTs for depression in primary care were systematically identified in Pubmed, PsycINFO, and CENTRAL. The distillation and matching model approach was used to abstract commonly used self-help techniques (practice elements). Study contexts associated with unique combinations of intervention elements were explored, including total human support dose (total face-to-face, telephone, and personalized email contact time recommended by the protocol), effective symptom domain (depression vs. general psychological distress), and severity of depression targeted by the study. Relative contribution to intervention success was estimated for individual elements and human support by conditional probability (CP, proportion of the number of times each element appeared in a successful intervention to the number of times it was used in the interventions identified by the review). RESULTS Twenty-one interventions (12 successful) in 20 RCTs and 21 practice elements were identified. Cognitive restructuring, behavioral activation, and homework assignment were elements appearing in > 80% of successful interventions. The dose of human support was positively associated with the proportion of interventions that were successful in a significant linear fashion (CPs: interventions with no support, 0.20; 1-119 min of support, 0.60; 120 min of support, 0.83; p = 0.042). In addition, human support increased the probability of success for most of the extracted elements. Only social support activation, homework assignment, and interpersonal skills were highly successful (CPs ≥ 0.60) when minimal support was provided. DISCUSSION These findings suggest that human support is an important component in creating an evidence-informed brief self-help program compatible with primary care settings.
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Creswell C, Nauta MH, Hudson JL, March S, Reardon T, Arendt K, Bodden D, Cobham VE, Donovan C, Halldorsson B, In-Albon T, Ishikawa SI, Johnsen DB, Jolstedt M, de Jong R, Kreuze L, Mobach L, Rapee RM, Spence SH, Thastum M, Utens E, Vigerland S, Wergeland GJ, Essau CA, Albano AM, Chu B, Khanna M, Silverman WK, Kendall PC. Research Review: Recommendations for reporting on treatment trials for child and adolescent anxiety disorders - an international consensus statement. J Child Psychol Psychiatry 2021; 62:255-269. [PMID: 32683742 DOI: 10.1111/jcpp.13283] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/03/2020] [Accepted: 05/12/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anxiety disorders in children and young people are common and bring significant personal and societal costs. Over the last two decades, there has been a substantial increase in research evaluating psychological and pharmacological treatments for anxiety disorders in children and young people and exciting and novel research has continued as the field strives to improve efficacy and effectiveness, and accessibility of interventions. This increase in research brings potential to draw together data across studies to compare treatment approaches and advance understanding of what works, how, and for whom. There are challenges to these efforts due largely to variation in studies' outcome measures and variation in the way study characteristics are reported, making it difficult to compare and/or combine studies, and this is likely to lead to faulty conclusions. Studies particularly vary in their reliance on child, parent, and/or assessor-based ratings across a range of outcomes, including remission of anxiety diagnosis, symptom reduction, and other domains of functioning (e.g., family relationships, peer relationships). METHODS To address these challenges, we convened a series of international activities that brought together the views of key stakeholders (i.e., researchers, mental health professionals, young people, parents/caregivers) to develop recommendations for outcome measurement to be used in treatment trials for anxiety disorders in children and young people. RESULTS AND CONCLUSIONS This article reports the results of these activities and offers recommendations for selection and reporting of outcome measures to (a) guide future research and (b) improve communication of what has been measured and reported. We offer these recommendations to promote international consistency in trial reporting and to enable the field to take full advantage of the great opportunities that come from data sharing going forward.
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Affiliation(s)
- Cathy Creswell
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Maaike H Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Jennifer L Hudson
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Sonja March
- School of Psychology and Counselling, University of Southern Queensland, Springfield, QLD, Australia
| | - Tessa Reardon
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Denise Bodden
- Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Vanessa E Cobham
- Children's Health QLD Child and Youth Mental Health Service, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Caroline Donovan
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Brynjar Halldorsson
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK.,Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy Unit, University of Koblenz and Landau, Landau, Germany
| | | | | | - Maral Jolstedt
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Rachel de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Leonie Kreuze
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Lynn Mobach
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia.,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Ronald M Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Susan H Spence
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia.,Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, QLD, Australia
| | | | - Elisabeth Utens
- Research Institute of Child Development and Education, University of Amsterdam / The Bascule / Amsterdam UMC, Amsterdam, The Netherlands.,Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sarah Vigerland
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Gro Janne Wergeland
- Division of Psychiatry, Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Cecilia A Essau
- Department of Psychology, University of Roehampton, London, UK
| | - Anne Marie Albano
- Columbia University Irving Medical Center, Columbia University, New York, NY, USA
| | - Brian Chu
- Department of Clinical Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Muniya Khanna
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Wendy K Silverman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
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Francis D, Hudson JL, Kohnen S, Mobach L, McArthur GM. The effect of an integrated reading and anxiety intervention for poor readers with anxiety. PeerJ 2021; 9:e10987. [PMID: 33665040 PMCID: PMC7912612 DOI: 10.7717/peerj.10987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/01/2021] [Indexed: 11/20/2022] Open
Abstract
A recent systematic review has reported that poor reading is reliably associated with anxiety. However, we currently lack evidence-based intervention for children who have both poor reading and anxiety (PRAX). In this study, we tested a new PRAX intervention in 8- to 12-year-old children using a double-baseline intervention case series design. Analyses of both group and individual data revealed that 12 weeks of PRAX intervention significantly improved children's reading and spelling accuracy, and significantly reduced both anxiety disorders and symptoms. These results support PRAX intervention as a treatment for comorbid reading and anxiety problems in children and pave the way to a randomised controlled trial.
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Affiliation(s)
- Deanna Francis
- Macquarie University Centre for Reading, Department of Cognitive Science, Macquarie University, NSW, Australia
| | - Jennifer L. Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW, Australia
| | - Saskia Kohnen
- Macquarie University Centre for Reading, Department of Cognitive Science, Macquarie University, NSW, Australia
| | - Lynn Mobach
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW, Australia
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Genevieve M. McArthur
- Macquarie University Centre for Reading, Department of Cognitive Science, Macquarie University, NSW, Australia
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Koerner K, Levy J, Dimeff LA. Using Technology to Train and Sustain Delivery of Evidence-Based Practices. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Sensoy Bahar O, Byansi W, Kivumbi A, Namatovu P, Kiyingi J, Ssewamala FM, McKay MM, Nyoni T. From "4Rs and 2Ss" to "Amaka Amasanyufu" (Happy Families): Adapting a U.S.-based Evidence-Based Intervention to the Uganda Context. FAMILY PROCESS 2020; 59:1928-1945. [PMID: 32027763 PMCID: PMC7416434 DOI: 10.1111/famp.12525] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In Uganda, one in five children presents mental health challenges, including disruptive behavior disorders (DBDs). DBDs can persist through adulthood and result in negative outcomes. Effective interventions for DBDs have been developed and tested in high-poverty communities in developed countries. Yet, most African countries, such as Uganda, lack such interventions. This paper describes the adaptation process of an evidence-based intervention of U.S. origin to optimize fit to context with intervention fidelity, as part of a randomized trial conducted with youth that exhibit behavioral challenges and their caregivers in 30 schools in Uganda. The process involved: initial meetings with headteachers and teachers to introduce the study and the main concepts of the intervention; initial manual review focusing on 4Rs and 2Ss content by the Uganda team; engagement of community stakeholders for additional feedback on content and cultural relevance; final revision of the manual; and collection of children's drawings for the illustration of the manual. This paper describes both similarities and differences between the original and adapted intervention content and methods of delivery. The findings also highlight the importance of involving community stakeholders in the adaptation process.
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Affiliation(s)
| | - William Byansi
- Brown School, Washington University in St. Louis, St. Louis, MO
| | - Apollo Kivumbi
- International Center for Child Health and Development, Uganda Field Office, Masaka, Uganda
| | - Phionah Namatovu
- International Center for Child Health and Development, Uganda Field Office, Masaka, Uganda
| | - Joshua Kiyingi
- International Center for Child Health and Development, Uganda Field Office, Masaka, Uganda
| | | | - Mary M McKay
- Brown School, Washington University in St. Louis, St. Louis, MO
| | - Thabani Nyoni
- Brown School, Washington University in St. Louis, St. Louis, MO
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Aggarwal S, Patton G, Berk M, Patel V. Design of a brief psychological intervention for youth who self-harm: a formative study in India. EVIDENCE-BASED MENTAL HEALTH 2020; 24:e2. [PMID: 33208508 DOI: 10.1136/ebmental-2020-300188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is an urgent need for context-specific research leading to development of scalable interventions to address self-harm and suicide in low and middle-income countries (LMICs). OBJECTIVE The current study was conducted to determine the contents of a psychological intervention to reduce recurrence of self-harm and improve functioning in youth who self-harm in India and finalise its delivery mechanisms. METHODS A systematic, sequential approach was used to integrate available scientific evidence, expert service providers' knowledge and experience, and service users' lived experiences in the codesigning and development of a psychological intervention. The steps included: identifying prioritised outcomes for youth who self-harm as well as a selection of feasible and acceptable elements from self-harm interventions that have been trialled in LMICs, intervention development workshops with mental health professionals and youth to finalise elements, a review of relevant treatment manuals to decide on the treatment framework, and finalising the treatment structure and schedule in the second round of intervention development workshops. FINDINGS We developed ATMAN treatment with three key elements; problem solving, emotion regulation and social network strengthening skills. The delivery schedule emphasises on the engagement elements, and allows for involvement of other stakeholders such as family members when acceptable to the clients. CONCLUSION AND CLINICAL IMPLICATIONS ATMAN treatment could prove to be especially effective in reducing self-harm recurrence in youth in India due to its brief schedule, elements that have been selected in collaboration with the service users and its potential to be scaled up for delivery by non-specialist treatment providers.
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Affiliation(s)
- Shilpa Aggarwal
- Faculty of Health, School of Medicine, Deakin University, Geelong, Victoria, Australia .,Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - George Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Berk
- Orygen (Centre for Youth Mental Health), Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Vikram Patel
- Harvard T H Chan School of Public Health, Global Health and Social Medicine, Boston, Massachusetts, USA
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Hogue A, Bobek M, MacLean A. Core Elements of CBT for Adolescent Conduct and Substance Use Problems: Comorbidity, Clinical Techniques, and Case Examples. COGNITIVE AND BEHAVIORAL PRACTICE 2020; 27:426-441. [PMID: 34103883 PMCID: PMC8184115 DOI: 10.1016/j.cbpra.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescent externalizing problems (AEPs), including serious conduct problems, delinquency, and substance misuse, are the most common adolescent behavioral issues in specialty care. High rates of comorbidity between conduct and substance use problems necessitate multidomain treatment strategies that can effectively address the AEP spectrum. One strategy to increase delivery of evidence-based interventions for multiproblem youth in usual care is to focus on core elements of empirically supported treatments that can be judiciously applied to clients presenting with diverse clinical profiles. This article describes six core practice elements of the cognitive-behavioral treatment (CBT) approach for AEPs: (1) Functional Analysis of Behavior Problems; (2) Prosocial Activity Sampling; (3) Cognitive Monitoring and Restructuring; (4) Emotion Regulation Training; (5) Problem-solving Training; (6) Communication Training. Integrated delivery of these core CBT elements is illustrated in two case examples, and implications for treatment planning for youth with AEPs are discussed.
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Affiliation(s)
- Aaron Hogue
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
| | - Molly Bobek
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
| | - Alexandra MacLean
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
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Ouellette RR, Goodman AC, Martinez-Pedraza F, Moses JO, Cromer K, Zhao X, Pierre J, Frazier SL. A Systematic Review of Organizational and Workforce Interventions to Improve the Culture and Climate of Youth-Service Settings. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:764-778. [PMID: 32303926 PMCID: PMC9872793 DOI: 10.1007/s10488-020-01037-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Both organizational culture and climate are associated with service quality and outcomes across youth-service settings. Increasing evidence indicates capacity of organizational interventions to promote a positive and effective culture and climate. Less is known about common intervention components across studies and service settings. The current systematic review reviewed 9223 citations and identified 31 studies, across six youth-service settings, measuring changes over time in organizational culture and climate following implementation of an organizational or workforce support intervention. Results highlight the promise of organizational interventions, a need for more comparison and randomized designs, and future directions for maximizing capacity of organizations to promote health for frontline providers and the children they serve.
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Magill M, Martino S, Wampold BE. The process of skills training: A content analysis of evidence-based addiction therapies. J Subst Abuse Treat 2020; 116:108063. [PMID: 32741504 PMCID: PMC7399208 DOI: 10.1016/j.jsat.2020.108063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/25/2020] [Accepted: 06/11/2020] [Indexed: 11/27/2022]
Abstract
OVERVIEW This work builds on previous efforts to delineate cross-cutting factors of evidence-based therapies. In this report, we target a single therapeutic factor-skills training for addictive behavior change-and we operationalize this factor in a manner that will aid clinical training and quality control. Specifically, we identify principles, which we defined as broader understandings on the part of the therapist that must be kept in mind when implementing a specific therapeutic practice. We define a practice as discrete action step or specific type of intervention that the therapist uses when addressing skills training content with clients. METHOD We conducted a literature review and qualitative content analysis of 30 source documents (i.e., therapy manuals, literature reviews, and government issued practice guidelines) and videos (i.e., therapy demonstration videos). We performed analysis of source materials in NVIVO. RESULTS We identified 10 principles and 30 therapeutic practices. Together, the principles suggest that skills training in evidence-based addiction therapies can be characterized as a client-centered approach to teaching and behavioral practice. The identified practices fell into four function themes: 1) client-centered goal-setting, 2) building client self-efficacy, 3) engaging in teaching, and 4) engaging in practice. CONCLUSIONS When the identified principles and practices are combined, they can inform a fidelity-based approach to behavioral skills training that is applicable to a wide range of alcohol or other drug (AOD) content topics, therapeutic modalities, and implementation settings. We discuss future implications regarding standardized training and fidelity assessment.
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Affiliation(s)
- Molly Magill
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI, United States of America.
| | - Steve Martino
- Yale University, New Haven, CT, United States of America
| | - Bruce E Wampold
- University of Wisconsin, Madison, WI, United States of America
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Pediatric Consultation-Liaison: Patient Characteristics and Considerations for Training in Evidence-Based Practices. J Clin Psychol Med Settings 2020; 28:529-542. [PMID: 32779089 DOI: 10.1007/s10880-020-09738-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Consultation-liaison services are an integral part of many pediatric hospital settings, yet characteristics of this patient population have not been extensively documented. The current study is a retrospective one-year chart review of the consultation-liaison service at a large pediatric hospital in the Southwestern United States. The purpose of this study is twofold: (1) to characterize this hospital's CL population and (2) to use these characteristics to identify preliminary evidence-based practices that should be considered for CL provider training. Identifying evidence-based practice elements that align with the characteristics of consultation-liaison patient populations may inform trainings for consultation-liaison staff. This would help to ensure that youth seen in hospital consultation-liaison services are getting the best available services, which is critical given the shortened time frame available to work with this patient population.
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Eskandari B, Pouretemad H, Mousavi M, Farahani H. Common elements of parent management training programs for preschool children with autism spectrum disorder. Asian J Psychiatr 2020; 52:102149. [PMID: 32442878 DOI: 10.1016/j.ajp.2020.102149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/15/2022]
Abstract
Parent management training is a general set of interventions used as a part of a variety of clinical approaches to reduce behavioral problems of children. These behavioral problems in children with special needs (such as autism spectrum disorder) take a more complex form. The objective is to present elements, needed to develop parent management training program to reduce behavioral problems in preschool children with autism spectrum disorder. At first, all parent management training programs for reducing behavioral problems of preschool children were collected. Subsequently, all programs were reviewed from the perspective of having a systematic review or meta-analysis, confirming the effectiveness of this program at preschool age. After that, interviews with experts and parents were conducted to identify effective elements on development of this program. In the next step, a set of components was obtained using information about parent management training programs as well as items obtained from interviews with experts and parents. At this stage, 10 experts were asked to rate the items according to their importance using the Delphi method. The items that achieved the required scores were introduced as main items. The number of them was 13 and included items such as full assessment of the child and appropriate communication with the child. Considering the characteristics of children with autism spectrum disorder will require changes in some parts of parent management training program, therefore, it is necessary to develop a specific program for these children to cover all of their characteristics.
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Affiliation(s)
| | - Hamidreza Pouretemad
- Institute for Cognitive and Brain Science, Shahid Beheshti University, Tehran, Iran.
| | - Masoumeh Mousavi
- Department of Psychology, Faculty of Psychology and Education Science, Shahid Beheshti University, Tehran, Iran
| | - Hojjatollah Farahani
- Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
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Duong MT, Cook CR, Lee K, Davis CJ, Vázquez-Colón CA, Lyon AR. User testing to drive the iterative development of a strategy to improve implementation of evidence-based practices in school mental health. ACTA ACUST UNITED AC 2020; 5:414-425. [PMID: 33763536 DOI: 10.1080/23794925.2020.1784052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Research has produced a steady stream of evidence-based practices (EBP) that can promote youth behavioral health, but widespread implementation is often poor. To narrow the "science to practice gap," an implementation strategy was developed to enhance school-based mental health providers' intentions to implement EBP. The current study adopted a user-testing approach to inform the iterative development of this implementation strategy, which consisted of strategic education, social influence techniques, and motivational interviewing. Segments of the implementation strategy were demonstrated live for a representative sample of the intended audience. Participants rated each segment on acceptability, appropriateness, and likely impact on intentions to use EBP. Ratings were tallied in real time and presented to participants to spur discussion. Qualitative input was coded via conventional content analyses. Results indicated that that implementation strategies may need to be tailored to the specific EBP. In addition, implementation goal setting was well-received by some participants but not others, suggesting a difficulty of conducting motivational interviewing in group settings. Participants also perceived themselves as familiar with EBP and strong advocates of school mental health services. The paper concludes with a discussion of how this research has influenced the ongoing development of the strategy and implications for EBP implementation efforts.
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Yonek J, Lee CM, Harrison A, Mangurian C, Tolou-Shams M. Key Components of Effective Pediatric Integrated Mental Health Care Models: A Systematic Review. JAMA Pediatr 2020; 174:487-498. [PMID: 32150257 PMCID: PMC7483725 DOI: 10.1001/jamapediatrics.2020.0023] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Emerging evidence suggests that integrated care models are associated with improved mental health care access and outcomes for youths (children ≤12 years and adolescents 12-21 years) served in pediatric primary care settings. However, the key components of these complex models remain unexamined. OBJECTIVE To identify and describe the key components of effective pediatric integrated mental health care models. EVIDENCE REVIEW The PubMed, Embase, PsycINFO, and Cochrane Controlled Register of Trials electronic databases were searched for relevant peer-reviewed articles published between January 1, 1985, and April 30, 2019. Articles were restricted to those published in the English language. Eligible articles reported original data on youths 17 years or younger, implemented an integrated mental health care model in a pediatric primary care setting, and assessed the model's association with primary outcomes (eg, mental health symptom severity) and secondary outcomes (eg, functional impairment and patient satisfaction). Articles that specified some degree of systematic coordination or collaboration between primary care and mental health professionals were included in the final review. Two independent reviewers extracted data on study design, model type, model components, level of integration, and outcomes. Study quality was assessed using the Jadad scale. Data were analyzed between January 1, 2018, and May 31, 2019. FINDINGS Eleven randomized clinical trials involving 2190 participants were included. Three studies focused on youths with depression, 3 on youths with attention-deficit/hyperactivity disorder, and 5 on youths with behavioral disorders. Most studies (9 of 11) implemented either the collaborative care model (n = 3), a slightly modified version of the collaborative care model (n = 2), or colocated care (n = 4). The most commonly reported components of effective pediatric integrated mental health care models were population-based care, measurement-based care, and delivery of evidence-based mental health services; all 3 components were present in studies reporting clinical improvement of mental health symptoms. Other model components, such as treatment-to-target or team-based care, were common in studies reporting specific outcomes, such as functional impairment. CONCLUSIONS AND RELEVANCE This review is the first to date to systematically search and qualitatively synthesize information on the key components of effective pediatric integrated mental health care models. This knowledge may be especially useful for pediatric primary care administrators in the selection of an integrated care model for their setting.
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Affiliation(s)
- Juliet Yonek
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco,Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco
| | - Chuan-Mei Lee
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco,Clinical Excellence Research Center, Stanford University, Stanford, California
| | - Anna Harrison
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco,Mental Health Service, San Francisco VA Medical Center San Francisco, San Francisco, California
| | - Christina Mangurian
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco,Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco
| | - Marina Tolou-Shams
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco,Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco
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44
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West AL, Dauber S, Gagliardi L, Correll L, Lilli AC, Daniels J. Systematic Review of Community- and Home-Based Interventions to Support Parenting and Reduce Risk of Child Maltreatment Among Families With Substance-Exposed Newborns. CHILD MALTREATMENT 2020; 25:137-151. [PMID: 31409120 DOI: 10.1177/1077559519866272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Substance-exposed newborns (SENs) are at increased risk of child maltreatment, out-of-home placement, and poor health and developmental outcomes. The purpose of this systematic review is to synthesize existing research on community- and home-based interventions designed to improve parenting and reduce risk of maltreatment for families with SENs, applying a program logic framework. The review includes studies that used preexperimental, quasi-experimental, and experimental designs. Twelve interventions were identified. Of the nine studies that used more rigorous experimental or quasi-experimental designs, five showed positive effects on at least one parenting or child maltreatment outcome, although some studies showed high risk of bias. Full coherence among the intended participants, theory of change, and program components was observed for only two interventions. The findings suggest a need for more rigorous research to develop and test interventions that are grounded in theory and prior research and that address the unique needs of families with SENs.
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Affiliation(s)
- Allison L West
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Laina Gagliardi
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Leeya Correll
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexandra Cirillo Lilli
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jane Daniels
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Espinet SD, Gotovac S, Knight S, Wissow L, Zwarenstein M, Lingard L, Steele M. Primary Care Practitioner Training in Child and Adolescent Psychiatry (PTCAP): A Cluster-Randomized Trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:319-329. [PMID: 31813273 PMCID: PMC7265617 DOI: 10.1177/0706743719890161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Rural primary care practitioners (PCPs) have a pivotal role to play in frontline pediatric mental health care, given limited options for referral and consultation. Yet they report a lack of adequate training and confidence to provide this care. The aim of this study was to test the effectiveness of the Practitioner Training in Child and Adolescent Psychiatry (PTCAP) program, which was designed to enhance PCPs' pediatric mental health care confidence. The program includes brief therapeutic skills and practice guidelines PCPs can use to address both subthreshold concerns and diagnosable conditions, themselves. METHODS The study design was a pilot, cluster-randomized, multicenter trial. Practices were randomly assigned to intervention (n practices = 7; n PCPs = 42) or to wait-list control (n practices = 6; n PCPs = 34). The intervention involved 8 hr of training in practice guidelines and brief therapeutic skills for depression, anxiety, attention deficit hyperactivity disorder, and behavioral disorders with case discussion and video examples, while the control practiced as usual. A linear random-effects model controlling for clustering and baseline was carried out on the individual-level data to examine between-group differences in the primary (i.e., confidence) and secondary (i.e., attitude and knowledge) outcomes at 1-week follow-up. RESULTS Findings were a statistically significant difference in the primary outcomes. Compared to the control group, the intervention group indicated significantly greater confidence in managing diagnosable conditions (d = 1.81) and general concerns (d = 1.73), as well as in making necessary referrals (d = 1.27) and obtaining consults (d = 0.74). While the intervention did not significantly impact secondary outcomes (attitudes and knowledge), regression analysis indicated that the intervention may have increased confidence, in part, by ameliorating the adverse impact of negative mental health care attitudes. CONCLUSION PTCAP enhances PCPs' child/youth mental health care confidence in managing both general and diagnosable concerns. However, an 8-hr session focused on applying brief therapeutic skills was insufficient to significantly change attitudes and knowledge. Formal testing of PTCAP may be warranted, perhaps using more intensive training and including outcome assessments capable of determining whether increased PCP confidence translates to more effective management and better patient outcomes.
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Affiliation(s)
- Stacey D Espinet
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Centre for Education Research and Innovation, The University of Western Ontario, London, Ontario, Canada
| | - Sandra Gotovac
- Division of Child and Adolescent Psychiatry, London Health Sciences Center, London, Ontario, Canada
| | - Sommer Knight
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Centre for Education Research and Innovation, The University of Western Ontario, London, Ontario, Canada
| | - Larry Wissow
- School of Medicine, University of Washington, DC, USA
| | - Merrick Zwarenstein
- Department of Family Medicine, Centre for Studies in Family Medicine, The University of Western Ontario, Ontario, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Health Sciences Addition, The University of Western Ontario, London, Ontario, Canada
| | - Margaret Steele
- Discipline of Psychiatry, Faculty of Medicine, Memorial University of Newfoundland, Saint John's, Newfoundland, Canada
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The Core Components of Evidence-Based Social Emotional Learning Programs. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:457-467. [PMID: 30443846 DOI: 10.1007/s11121-018-0953-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Implementing social emotional learning (SEL) programs in school settings is a promising approach to promote critical social and emotional competencies for all students. However, there are several challenges to implementing manualized SEL programs in schools, including program cost, competing demands, and content that is predetermined and cannot be tailored to individual classroom needs. Identifying core components of evidence-based SEL programs may make it possible to develop more feasible approaches to implementing SEL in schools. The purpose of this study was to systematically identify the core components in evidence-based elementary school SEL programs, using the five interrelated sets of competencies identified by the Collaborative for Academic, Social, and Emotional Learning (CASEL) as an organizing framework. We present the components that were identified, and the rates at which each component was included in the sample of evidence-based SEL programs. The core components that occurred most frequently across programs were Social Skills (100% of programs), Identifying Others' Feelings (100% of programs), Identifying One's Own Feelings (92.3% of programs), and Behavioral Coping Skills/Relaxation (91.7% of programs). These findings illustrate the feasibility of systematically identifying core components from evidence-based SEL programs and suggest potential utility of developing and evaluating modularized SEL programs.
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Boustani MM, Frazier SL, Chu W, Lesperance N, Becker KD, Helseth SA, Hedemann ER, Ogle RR, Chorpita BF. Common Elements of Childhood Universal Mental Health Programming. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:475-486. [PMID: 32080783 DOI: 10.1007/s10488-020-01023-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the availability of multiple mental health prevention and promotion programs for children, challenges related to their dissemination limit their reach and impact. This review identifies the most common practice elements of effective childhood universal mental health programming for children ages 3-11, based on a structured interpretation and coding of program manuals and descriptions in peer-reviewed articles. Across a range of program goals and targeted outcomes, psychoeducation and problem solving emerged as the most common practice elements, followed by social skills training, insight building, and communication skills. These skills were largely taught via role-plays and modeling. Synthesizing what we know from the universal mental health programming literature has potential to facilitate dissemination of information to inform the development, adaptation or adoption of programs for children.
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Affiliation(s)
- Maya M Boustani
- Department of Psychology, Loma Linda University, 11130 Anderson St., Suite 117, Loma Linda, CA, 92350, USA.
| | | | - Wendy Chu
- University of California, Los Angeles, Los Angeles, CA, USA
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Becker KD, Domitrovich CE. The Conceptualization, Integration, and Support of Evidence-Based Interventions in the Schools. SCHOOL PSYCHOLOGY REVIEW 2019. [DOI: 10.1080/02796015.2011.12087531] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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49
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Wolk CB, Becker-Haimes EM, Fishman J, Affrunti NW, Mandell DS, Creed TA. Variability in clinician intentions to implement specific cognitive-behavioral therapy components. BMC Psychiatry 2019; 19:406. [PMID: 31852471 PMCID: PMC6921500 DOI: 10.1186/s12888-019-2394-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/05/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND CBT comprises many discrete components that vary in complexity, but implementation and training efforts often approach CBT as a single entity. We examined variability in clinician intentions to use different structural and interventional components of CBT for three different clinical groups: clients receiving CBT, clients with depression, and clients with anxiety. METHODS Clinicians (n = 107) trained in CBT completed a one-time electronic survey. Clinicians' intentions were measured using established item stems from social psychology adapted to examine intentions to use six specific CBT components: exposure therapy, cognitive restructuring, behavioral activation, planning homework, reviewing homework, and agenda-setting. RESULTS Intentions were weakest, on average, for exposure. They were strongest, on average, for reviewing homework. A series of ANOVAs with Tukey's post-hoc tests revealed that participants intended to use exposure with clients receiving CBT (p = .015) and clients with anxiety (p < .001) significantly more than for clients with depression. Participants intended to use behavioral activation with clients with depression (p = .01) significantly more than for clients with anxiety. No other intentions to use CBT components differed among these three clinical populations. CONCLUSIONS When studying determinants of CBT use and designing interventions to increase use, implementers should consider that different CBT components may require different implementation strategies. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA.
| | - Emily M. Becker-Haimes
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104 USA ,Hall-Mercer Community Mental Health Center, Philadelphia, PA USA
| | - Jessica Fishman
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104 USA ,0000 0004 1936 8972grid.25879.31Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA ,0000 0004 1936 8972grid.25879.31Annenberg School for Communication, University of Pennsylvania, Philadelphia, USA
| | - Nicholas W. Affrunti
- 0000 0001 1010 7993grid.431691.8National Association of School Psychologists, Bethesda, MD USA
| | - David S. Mandell
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104 USA ,0000 0004 1936 8972grid.25879.31Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Torrey A. Creed
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104 USA
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Receipt and targeting of evidence-based psychosocial interventions for people living with psychoses: findings from the second Australian national survey of psychosis. Epidemiol Psychiatr Sci 2019; 28:613-629. [PMID: 29893656 PMCID: PMC6998989 DOI: 10.1017/s2045796018000288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS. Clinical Practice Guidelines (CPGs) recommend evidence-based psychosocial interventions (EBPIs) to improve consumer recovery; however, availability appears limited. We describe receipt of six EBPIs, reported by people with psychoses, and associations with service and consumer characteristics, including indicators of need (eligibility) and benefit (suitability). METHODS. Participants in the 2010 Australian national survey of psychosis (n = 1825) were interviewed to assess demographic, functional, mental and physical health characteristics and service use in the previous year. Six EBPIs (Cognitive Behaviour Therapy for psychosis; Family Psycho-Education (FPE); Relapse Prevention Planning (RPP); Skills Training; Supported Employment; and Assertive Community Treatment) were chosen, based on the strength and consistency of CPG recommendations. Associations between receipt of interventions and eligibility and suitability indicators were examined via correlations and χ2. Logistic regression was used to predict receipt of one or more EBPIs and to identify predictors of each individual EBPI. RESULTS. Less than one-quarter of the sample reported receipt of an evidence-based level of any intervention: rates ranged from 3.4% (FPE) to 21.1% (RPP). The model predicting receipt of one or more EBPIs was statistically significant (χ2 (20, n = 1746) = 216.12, p < 0.01) and marginally useful. Nine variables contributed uniquely, of which six were service characteristics. The strongest predictors of receipt were being assigned a psychologist as a case manager (p < 0.01, OR(CI) = 2.36(1.50-3.72)) and accessing a non-clinical mental health support service in the past year (p < 0.01, OR(CI) = 2.01(1.60-2.51)). CONCLUSIONS. Prior reports of limited receipt of EBPIs are reinforced. There is patchy evidence for targeting of EBPIs to those who might benefit most. Service characteristics contribute more to the prediction of receipt than clinical characteristics. Greater implementation effort and better targeting are required to bridge evidence-practice gaps, including improved evidence-based practice literacy among professionals and needs-based service re-design to improve provision and optimise consumer outcomes.
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