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Nordmo M, Monsen JT, Høglend PA, Solbakken OA. Investigating the dose–response effect in open-ended psychotherapy. Psychother Res 2020; 31:859-869. [DOI: 10.1080/10503307.2020.1861359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Magnus Nordmo
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Jon T. Monsen
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Per Andreas Høglend
- Institute of Clinical Medicine, Division of Mental Health and Addiction, University of Oslo, Oslo, Norway
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Allary A, Proulx-Tremblay V, Bélanger C, Hudon C, Marchand A, O'Connor K, Pérodeau G, Roberge P, Tannenbaum C, Vasiliadis HM, Desrosiers C, Cruz-Santiago D, Grenier S. Psychological predictors of benzodiazepine discontinuation among older adults: Results from the PASSE 60. Addict Behav 2020; 102:106195. [PMID: 31838367 DOI: 10.1016/j.addbeh.2019.106195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Long-term benzodiazepine (BZD) use among seniors is mostly inappropriate and associated with adverse health outcomes. To prevent these consequences, withdrawal is crucial, yet knowledge is limited about what predicts BZD discontinuation. Until now, most studies have focused on sociodemographic and BZD intake factors as predictors while neglecting psychological factors. This research addresses this issue by studying how the intensity of depressive symptoms, social support satisfaction, self-perceived competence in the ability to withdraw, and overall quality of sleep predict discontinuation in long-term older consumers. METHOD Seventy-three participants aged 60 years and older were enrolled in this study. There were four time measures: before discontinuation (T1), after (T2), 3 months after (T3), and 12 months after (T4). Data were collected in the "Programme d'Aide du Succès au SEvrage" (PASSE-60+) study. RESULTS Social support satisfaction predicted discontinuation at T2 and T4. Self-perceived competence in the ability to withdraw and depressive symptoms predicted discontinuation at T4. This later prediction was counterintuitive; higher depressive symptoms at T1 were linked with higher discontinuation success. BZD intake factors (length of use and dose) were good predictors for short term discontinuation. Psychological factors were moderate predictors for short term and good predictors for long term discontinuation. CONCLUSION Psychological factors are good predictors of discontinuation and are better predictors than BZD intake factors of long-term discontinuation. Discontinuation programs should focus on social support and self-perceived competence to improve their efficacy. Further studies are needed to acquire a more complete picture of the psychological predictors of discontinuation success. ClinicalTrials.gov Identifier: NCT02281175.
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Affiliation(s)
- Arnaud Allary
- Département de psychologie, Université du Québec à Montréal (UQAM), Québec, Canada; Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Québec, Canada
| | - Virginie Proulx-Tremblay
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Québec, Canada; Département de psychologie, Université de Montréal, Québec, Canada
| | - Claude Bélanger
- Département de psychologie, Université du Québec à Montréal (UQAM), Québec, Canada
| | - Carol Hudon
- École de psychologie de l'Université Laval, Québec, Canada; Centre de recherche CERVO, Québec, Canada
| | - André Marchand
- Département de psychologie, Université du Québec à Montréal (UQAM), Québec, Canada
| | - Kieron O'Connor
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Québec, Canada
| | - Guilhème Pérodeau
- Département de psychoéducation et de psychologie, Université du Québec en Outaouais (UQO), Québec, Canada
| | - Pasquale Roberge
- Département de médecine de famille et de médecine d'urgence à l'Université de Sherbrooke, Québec, Canada
| | - Cara Tannenbaum
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Québec, Canada; Faculté de médicine, Université de Montréal, Québec, Canada; Faculté de pharmacie, Université de Montréal, Québec, Canada
| | | | - Caroline Desrosiers
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Québec, Canada
| | - Diana Cruz-Santiago
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Québec, Canada; Département de médecine familiale et de médecine d'urgence, Université de Montréal, Québec, Canada
| | - Sébastien Grenier
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Québec, Canada; Département de psychologie, Université de Montréal, Québec, Canada.
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Roe D, Mazor Y, Gelkopf M. Patient-reported outcome measurements (PROMs) and provider assessment in mental health: a systematic review of the context of implementation. Int J Qual Health Care 2019; 34:ii28–ii39. [DOI: 10.1093/intqhc/mzz084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/25/2019] [Accepted: 08/02/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Purpose
To review and integrate the vast amount of literature yielded by recent growing interest in patient-reported outcome measurement and routine outcome measures (PROMs/ROMs), in order to suggest options and improvements for implementation. PROMs are the systematic assessment of service users’ health using standardized self-report measures. Specifically, for ROMs, it includes routine provider or caretaker assessment measures. Both are administered to ascertain routinely, the impact of treatment in mental health settings and to improve care. A review is needed because of the large differences in setting, conceptualization, practice and implementation. Here, we examine the different major projects worldwide.
Data sources
Psych INFO and PubMed including Medline, Biomed Central, EMBASE Psychiatry and Elsevier Science’s Direct.
Study selection
We conducted a systematized review of the literature published from 2000 to 2018 on the implementation and sustainability of PROMs and ROMs in mental health services for adults.
Data extraction, synthesis and Results
We described and characterized the programs in different countries worldwide. We identified 103 articles that met the inclusion criteria, representing over 80 PROMs/ROMs initiatives in 15 countries. National policy and structure of mental health services were found to be major factors in implementation. We discuss the great variability in PROMs/ROMs models in different countries, making suggestions for their streamlining and improvement.
Conclusion
We extracted valuable information on the different characteristics of the numerous PROMs/ROMs initiatives worldwide. However, in the absence of a strong nationwide policy effort and support, implementation seems scattered and irregular. Thus, development of the implementation of PROMs/ROMs is left to groups of enthusiastic clinicians and researchers, making sustainability problematic.
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Affiliation(s)
- David Roe
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838 Israe
- Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
- Department of Clinical Medicine, Psychiatry, Aalborg University, Denmark
| | - Yael Mazor
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838 Israe
- Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838 Israe
- Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
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Dobud WW, Harper NJ. Of Dodo birds and common factors: A scoping review of direct comparison trials in adventure therapy. Complement Ther Clin Pract 2018; 31:16-24. [DOI: 10.1016/j.ctcp.2018.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/16/2017] [Accepted: 01/18/2018] [Indexed: 12/14/2022]
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Antunes RP, Sales CMD, Elliott R. The clinical utility of the Personal Questionnaire (PQ): a mixed methods study. COUNSELLING PSYCHOLOGY QUARTERLY 2018. [DOI: 10.1080/09515070.2018.1439451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- R. P. Antunes
- Department of Psychology, University of Évora, Évora, Portugal
| | - C. M. D. Sales
- Faculty of Psychology and Education Sciences at the University of Porto (FPCEUP), Center for Psychologyat the University of Porto (CPUP), Porto, Portugal
| | - R. Elliott
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, Scotland
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Macdonald G, Livingstone N, Hanratty J, McCartan C, Cotmore R, Cary M, Glaser D, Byford S, Welton NJ, Bosqui T, Bowes L, Audrey S, Mezey G, Fisher HL, Riches W, Churchill R. The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis. Health Technol Assess 2018; 20:1-508. [PMID: 27678342 DOI: 10.3310/hta20690] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. OBJECTIVES To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. STUDY DESIGN For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. PARTICIPANTS Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. INTERVENTIONS Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. MAIN OUTCOME MEASURES Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. METHODS Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. RESULTS We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. CONCLUSIONS It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. LIMITATIONS Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. FUTURE WORK Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003889. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Geraldine Macdonald
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK.,School for Policy Studies, University of Bristol, Bristol, UK
| | - Nuala Livingstone
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK
| | - Jennifer Hanratty
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK
| | - Claire McCartan
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK
| | - Richard Cotmore
- Evaluation Department, National Society for the Prevention of Cruelty to Children (NSPCC), London, UK
| | - Maria Cary
- King's Health Economics, King's College London, London, UK
| | - Danya Glaser
- University College London and Great Ormond Street Hospital for Sick Children, London, UK
| | - Sarah Byford
- King's Health Economics, King's College London, London, UK
| | - Nicky J Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tania Bosqui
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK
| | - Lucy Bowes
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Suzanne Audrey
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Gill Mezey
- Population Health Sciences and Education, St George's, University of London, London, UK
| | - Helen L Fisher
- King's Health Economics, King's College London, London, UK
| | - Wendy Riches
- Riches and Ullman Limited Liability Partnership, London, UK
| | - Rachel Churchill
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Husen K, Rafaeli E, Rubel JA, Bar-Kalifa E, Lutz W. Daily affect dynamics predict early response in CBT: Feasibility and predictive validity of EMA for outpatient psychotherapy. J Affect Disord 2016; 206:305-314. [PMID: 27662571 DOI: 10.1016/j.jad.2016.08.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous studies have shown that individual differences in affect dynamics during depressed patients' everyday lives allow the prediction of treatment outcome and of symptom reoccurrence in remitted patients. In this study, we analyze whether understanding patients' affective states and their fluctuation patterns helps predict early treatment response (until session 5). METHODS Ecological Momentary Assessment (EMA) strategies allow in-depth analyses of real-time affective states and of their dynamics. Repeated assessments were made four times a day during a two-week period to capture real-life affective states (positive affect, PA and negative affect, NA) and dynamics (fluctuations in NA and PA) before the start of outpatient treatment of 39 patients. Due to the nested structure of the data, hierarchical linear models were conducted. RESULTS PA/NA ratios, as well as fluctuations in NA predicted early treatment response, even when adjusting for initial impairment. In contrast, mean levels of NA or PA, as well as fluctuations in PA did not predict treatment response. LIMITATIONS The time between the EMA assessment and treatment onset varied between patients. However, this variation was not associated with early change. CONCLUSIONS The results suggest that pre-treatment affect dynamics could provide valuable information for predicting treatment response independent of initial impairment levels. Better predictions of early treatment response help to improve treatment choices early in the treatment progress.
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Affiliation(s)
- K Husen
- Clinical Psychology & Psychotherapy, University of Trier, Germany.
| | - E Rafaeli
- Department of Psychology, Bar-Ilan University, Israel
| | - J A Rubel
- Clinical Psychology & Psychotherapy, University of Trier, Germany
| | - E Bar-Kalifa
- Department of Psychology, Bar-Ilan University, Israel
| | - W Lutz
- Clinical Psychology & Psychotherapy, University of Trier, Germany
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8
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Gillis HL, Speelman E, Linville N, Bailey E, Kalle A, Oglesbee N, Sandlin J, Thompson L, Jensen J. Meta-analysis of Treatment Outcomes Measured by the Y-OQ and Y-OQ-SR Comparing Wilderness and Non-wilderness Treatment Programs. CHILD & YOUTH CARE FORUM 2016. [DOI: 10.1007/s10566-016-9360-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sherman AC, Mosier J, Leszcz M, Burlingame GM, Ulman KH, Cleary T, Simonton S, Latif U, Hazelton L, Strauss B. Group Interventions for Patients with Cancer and HIV Disease: Part III. Moderating Variables and Mechanisms of Action. Int J Group Psychother 2015; 54:347-87. [PMID: 15253509 DOI: 10.1521/ijgp.54.3.347.40339] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Growing evidence supports the value of group interventions for individuals who are at risk for or have developed cancer or HIV disease. However, information is more limited concerning how these services can be delivered in an optimal manner, and what processes contribute to their benefits. Parts I and II of this review examined the efficacy of different interventions for individuals at different phases of illness, ranging from primary prevention to late-stage disease, in both psychosocial and biological domains. The current paper examines some of the factors other than phase of illness that might influence group treatment effects (e.g., intervention parameters, participant characteristics), and explores mechanisms of action.
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Affiliation(s)
- Allen C Sherman
- Department of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock 72205, USA.
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Andersen BL, Dorfman CS. Evidence-based psychosocial treatment in the community: considerations for dissemination and implementation. Psychooncology 2015; 25:482-90. [PMID: 27092813 DOI: 10.1002/pon.3864] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 04/05/2015] [Accepted: 05/10/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND In psycho-oncology care, steps toward dissemination and implementation of evidence-based treatments (EBTs) have not been made. For this to change, factors associated with real-world dissemination and implementation must be identified. In the community, providers, their organizations, and patients are key stakeholders. METHOD A focused review of literatures in continuing education, dissemination, and implementation of mental health services is provided. RESULTS Early-career providers are most ready to implement as they have greater openness and more positive attitudes toward EBTs. Current continuing education practices to teach EBTs have limited effectiveness. Instruction using interactive strategies tailored to therapists' clinical needs and the provision of post-education consultation is needed. There is tension between EBT delivery with fidelity and the necessity for adaptation. EBT service provision is the key outcome of implementation, and documenting such is important to patients, providers, and organizations. CONCLUSION A multilevel conceptual framework, Setting, Therapist, Education, imPlementation, and Sustainability, is offered and provides directions for dissemination and sustainable implementation. Guidelines from the Commission on Cancer of the American College of Surgeons and the American Society of Clinical Oncology underscore the timeliness of the proposed framework to move EBTs from the research settings where they were developed to the practice settings where they are needed.
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Reuter L, Munder T, Altmann U, Hartmann A, Strauss B, Scheidt CE. Pretreatment and process predictors of nonresponse at different stages of inpatient psychotherapy. Psychother Res 2015; 26:410-24. [PMID: 25959603 DOI: 10.1080/10503307.2015.1030471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Up to 50% of psychotherapeutic treatments end without significant improvements. While there is first evidence about predictors of nonresponse in outpatient psychotherapy, there are currently no studies investigating predictors of nonresponse in inpatient settings. Based upon a previous systematic literature review, we analyzed the predictive value of initial patient characteristics on nonresponse in symptom distress. METHODS Treatment episodes from 546 patients, treated for at least 4 weeks, were assessed under naturalistic conditions. Nonresponse status (i.e., lack of a reliable improvement in symptom distress) was investigated at four different time points: at week 4, at discharge, and at a two follow-ups (3 and 12 months after discharge). Hierarchical binary logistic regression models were used to predict nonresponse. Sociodemographic data, clinical variables, and the previous response status were entered subsequently in the model. RESULTS A moderate or functional level of initial symptom distress, a comorbid personality disorder, and previous nonresponse were the most consistent predictors of nonresponse. CONCLUSIONS The results point to the importance of early outcome assessment and suggest the implementation of more symptom-specific treatments.
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Affiliation(s)
- Laurence Reuter
- a Universitätsklinikum Freiburg, Zentrum für psychische Erkrankungen, Klinik für psychosomatische Medizin und Psychotherapie , Freiburg im Breisgau , Germany.,b Institut für Psychosoziale Medizin und Psychotherapie , Friedrich-Schiller Universität , Jena , Germany
| | - Thomas Munder
- c Psychologische Hochschule Berlin , Berlin , Germany
| | - Uwe Altmann
- b Institut für Psychosoziale Medizin und Psychotherapie , Friedrich-Schiller Universität , Jena , Germany
| | - Armin Hartmann
- a Universitätsklinikum Freiburg, Zentrum für psychische Erkrankungen, Klinik für psychosomatische Medizin und Psychotherapie , Freiburg im Breisgau , Germany
| | - Bernhard Strauss
- b Institut für Psychosoziale Medizin und Psychotherapie , Friedrich-Schiller Universität , Jena , Germany
| | - Carl Eduard Scheidt
- a Universitätsklinikum Freiburg, Zentrum für psychische Erkrankungen, Klinik für psychosomatische Medizin und Psychotherapie , Freiburg im Breisgau , Germany
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Murphy JM, Blais M, Baer L, McCarthy A, Kamin H, Masek B, Jellinek M. Measuring outcomes in outpatient child psychiatry: reliable improvement, deterioration, and clinically significant improvement. Clin Child Psychol Psychiatry 2015; 20:39-52. [PMID: 23838693 DOI: 10.1177/1359104513494872] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Given the increasing interest in demonstrating effectiveness in psychiatric treatment, the current paper seeks to advance outcome measurement in child psychiatry by demonstrating how more informative analytic strategies can be used to evaluate treatment in a real world setting using a brief, standardized parent-report measure. Questionnaires were obtained at intake for 1294 patients. Of these, 695 patients entered treatment and 531 (74%) had complete forms at intake and follow-up. Using this sample, we analyzed the data to determine effect sizes, rates of reliable improvement and deterioration, and rates of clinically significant improvement. Findings highlighted the utility of these approaches for evaluating treatment outcomes. Further suggestions for improving outcome measurement and evaluation are provided.
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Affiliation(s)
- J Michael Murphy
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Mark Blais
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Lee Baer
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Alyssa McCarthy
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA
| | - Hayley Kamin
- Department of Psychology, University of Florida, Gainesville, USA
| | - Bruce Masek
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Michael Jellinek
- Department of Psychiatry, Harvard Medical School, Boston, USA Partners Healthcare, Boston, USA
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Clarke N, Mun EY, Kelly S, White HR, Lynch K. Treatment outcomes of a combined cognitive behavior therapy and pharmacotherapy for a sample of women with and without substance abuse histories on an acute psychiatric unit: do therapeutic alliance and motivation matter? Am J Addict 2013; 22:566-73. [PMID: 24131164 PMCID: PMC3989070 DOI: 10.1111/j.1521-0391.2013.12013.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 03/07/2012] [Accepted: 10/23/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Women with comorbid psychiatric and substance abuse problems (PwSA) experience more consequences from their use and typically have the poorest prognosis and outcome, compared to those with psychiatric problems but without substance abuse problems (PwoSA). The present study examined outcomes of a combined intensive inpatient cognitive behavior therapy (CBT) and pharmacotherapy program for women with PwSA and PwoSA. METHODS Sample consisted of 117 women on a women-only acute inpatient unit (PwSA = 50, PwoSA = 67). RESULTS Women in both groups made significant improvements in psychological functioning. High motivation at admission and therapeutic alliance at discharge were associated with improved psychological functioning at discharge for both groups. SCIENTIFIC SIGNIFICANCE Findings provide preliminary support for the efficacy of a combined CBT and pharmacotherapy program for women with psychiatric diagnoses on a women-only acute inpatient unit, and for pre-treatment motivation and therapeutic alliance as important correlates of better treatment outcomes.
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Affiliation(s)
- Nickeisha Clarke
- Rutgers, The State University of New Jersey, Piscataway, New Jersey
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Haberer JE, Trabin T, Klinkman M. Furthering the reliable and valid measurement of mental health screening, diagnoses, treatment and outcomes through health information technology. Gen Hosp Psychiatry 2013; 35:349-53. [PMID: 23628162 PMCID: PMC3692579 DOI: 10.1016/j.genhosppsych.2013.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 03/20/2013] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Measurement of mental health is challenging; however, many solutions may be found through the use of health information technology. METHOD This article reviews current approaches to measuring mental health, focusing on screening, diagnosis, treatment, and outcomes. It then identifies several key areas in which health information technology may advance the field and provide reliable and valid measurements that are readily available to and manageable for providers, as well as acceptable, feasible, and sustainable for selected populations. RESULT AND CONCLUSIONS Although new technologies must overcome many challenges, including privacy, efficiency, cost, and scalability, it is an exciting and fast-growing field with many potential applications and clinical benefit.
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Affiliation(s)
- Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Reese RJ, Toland MD, Hopkins NB. Replicating and extending the good-enough level model of change: considering session frequency. Psychother Res 2011; 21:608-19. [PMID: 21777115 DOI: 10.1080/10503307.2011.598580] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The good-enough level (GEL) model posits that the rate of change in psychotherapy is related to the total dose of therapy. The psychotherapy dose-response literature has typically measured dose as number of sessions attended without considering the number of days or weeks it takes to complete the sessions (session frequency). The current study sought to replicate the GEL model and explore if session frequency moderates the influence that the number of sessions has on the rate of change in psychotherapy. An archived naturalistic data set with a US university counseling center sample (n=1,207), with treatment progress measured using the Outcome Questionnaire-45 (Lambert et al., 1996), was used. Our results are consistent with the GEL model (i.e., clients who attended fewer sessions evidenced faster rates of change), but extended it by showing that the rate of change was also influenced by session frequency (i.e., clients who attended more sessions on average per week demonstrated more rapid improvement). Evidence suggests that clinicians and researchers should give consideration to session frequency, both in their work with clients and how "dose" is operationalized in psychotherapy research.
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Affiliation(s)
- Robert J Reese
- University of Kentucky, Educational, School, & Counseling Psychology, 235 Dickey Hall, Lexington 40506-0017, USA.
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17
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Blais MA, Sinclair SJ, Baity MR, Worth J, Weiss AP, Ball LA, Herman J. Measuring Outcomes in Adult Outpatient Psychiatry. Clin Psychol Psychother 2011; 19:203-13. [DOI: 10.1002/cpp.749] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Matthew R. Baity
- Alliant International University; California School of Professional Psychology; Sacramento; CA; USA
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18
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Vannoy SD, Robins LS. Suicide-related discussions with depressed primary care patients in the USA: gender and quality gaps. A mixed methods analysis. BMJ Open 2011; 1:e000198. [PMID: 22021884 PMCID: PMC3191598 DOI: 10.1136/bmjopen-2011-000198] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective To characterise suicide-risk discussions in depressed primary-care patients. Design Secondary analysis of recordings and self reports by physicians and patients. Descriptive statistics of depression and suicide-related discussion, with qualitative extraction of disclosure, enquiry and physician response. Setting 12 primary-care clinics between July 2003 and March 2005. Participants 48 primary-care physicians and 1776 adult patients. Measures Presence of depression or suicide-related discussions during the encounter; patient and physician demographics; depression symptom severity and suicide ideation as measured by the Patient Health Questionnaire (PHQ9); physician's decision-making style as measured by the Medical Outcomes Study Participatory Decision-Making Scale; support for autonomy as measured by the Health Care Climate Questionnaire; trust in their physician as measured by the Primary Care Assessment Survey; physician response to suicide-related enquiry or disclosure. Results Of the 1776 encounters, 128 involved patients scoring >14 on the PHQ9. These patients were seen by 43 of the 48 physicians. Suicide ideation was endorsed by 59% (n=75). Depression was discussed in 52% of the encounters (n=66). Suicide-related discussion occurred in only 11% (n=13) of encounters. 92% (n=12) of the suicide discussions occurred with patients scoring <2 on PHQ9 item 9. Suicide was discussed in only one encounter with a male. Variation in elicitation and response styles demonstrated preferred and discouraged interviewing strategies. Conclusions Suicide ideation is present in a significant proportion of depressed primary care patients but rarely discussed. Men, who carry the highest risk for suicide, are unlikely to disclose their ideation or be asked about it. Patient-centred communication and positive healthcare climate do not appear to increase the likelihood of suicide related discussion. Physicians should be encouraged to ask about suicide ideation in their depressed patients and, when disclosure occurs, facilitate discussion and develop targeted treatment plans.
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Affiliation(s)
- Steven D Vannoy
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Lynne S Robins
- Department of Medical Education and Bioinformatics, University of Washington, Seattle, Washington, USA
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19
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20
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Tzoumas AC, Tzoumas JL, Burlingame GM, Nelson PL, Wells MG, Gray DD. The Y-OQ-12: psychosocial screening of youth in primary care medicine using items from an outcome measure. Clin Psychol Psychother 2007. [DOI: 10.1002/cpp.554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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21
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Barlow SH, Burlingame GM. Essential theory, processes, and procedures for successful group psychotherapy: Group cohesion as exemplar. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2006. [DOI: 10.1007/bf02729053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Eisen SV, Gerena M, Ranganathan G, Esch D, Idiculla T. Reliability and validity of the BASIS-24 Mental Health Survey for Whites, African-Americans, and Latinos. J Behav Health Serv Res 2006; 33:304-23. [PMID: 16752108 DOI: 10.1007/s11414-006-9025-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Increasing racial and ethnic diversity calls for mental health assessment instruments that are appropriate, reliable, and valid for the wide range of cultures that comprise the current US population. However, most assessment instruments have not been tested on diverse samples. This study assessed psychometric properties and sensitivity to change of the revised Behavior and Symptom Identification Scale (BASIS-24) among the three largest race/ethnicity groups in the USA: Whites, African-Americans, and Latinos. BASIS-24 assessments were obtained for 2436 inpatients and 2975 outpatients treated at one of 27 mental health and/or substance abuse programs. Confirmatory factor analysis and several psychometric tests supported the factor structure, reliability, concurrent validity, and sensitivity of the instrument within each race/ethnicity group, although discriminant validity may be weaker for African-Americans and Latinos than for Whites. Further research is needed to test and validate assessment instruments with other race/ethnicity groups.
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Affiliation(s)
- Susan V Eisen
- Health Services Department, Boston University School of Public Health, Boston, MA, USA.
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23
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Tiet QQ, Byrnes HF, Barnett P, Finney JW. A practical system for monitoring the outcomes of substance use disorder patients. J Subst Abuse Treat 2006; 30:337-47. [PMID: 16716849 DOI: 10.1016/j.jsat.2006.03.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Accepted: 03/13/2006] [Indexed: 11/26/2022]
Abstract
Outcomes monitoring and management are receiving mounting attention because of increased emphasis on health care accountability and cost containment. Efficient, practical outcomes monitoring systems (OMSs) are crucial if health care system performance is to be determined and effective/cost-effective treatments are to be identified, but such practical monitoring systems generally are lacking. This article describes the features of such a system for monitoring the care received by, and the substance use and psychosocial outcomes of, patients treated for substance use disorders (SUDs) in the Department of Veterans Affairs (VA). In contrast to a 15-21% follow-up rate achieved by VA SUD program staff under a previously mandated system-wide monitoring system, the monitoring system used in this project achieved a 67% follow-up rate without paying patients for their participation. We provide data on patient characteristics and treatment outcomes, estimate the cost of implementing this type of monitoring system on a broad scale, and provide recommendations for OMSs in other large health care organizations.
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Affiliation(s)
- Quyen Q Tiet
- Department of Veterans Affairs Palo Alto Health Care System, Center for Health Care Evaluation, Menlo Park, CA 94025, USA.
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24
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Wampold BE, Brown GSJ. Estimating variability in outcomes attributable to therapists: a naturalistic study of outcomes in managed care. J Consult Clin Psychol 2006; 73:914-23. [PMID: 16287391 DOI: 10.1037/0022-006x.73.5.914] [Citation(s) in RCA: 210] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To estimate the variability in outcomes attributable to therapists in clinical practice, the authors analyzed the outcomes of 6,146 patients seen by approximately 581 therapists in the context of managed care. For this analysis, the authors used multilevel statistical procedures, in which therapists were treated as a random factor. When the initial level of severity was taken into account, about 5% of the variation in outcomes was due to therapists. Patient age, gender, and diagnosis as well as therapist age, gender, experience, and professional degree accounted for little of the variability in outcomes among therapists. Whether or not patients were receiving psychotropic medication concurrently with psychotherapy did affect therapist variability. However, the patients of the more effective therapists received more benefit from medication than did the patients of less effective therapists.
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Affiliation(s)
- Bruce E Wampold
- Department of Counseling Psychology, University of Wisconsin, Madison, WI 53562, USA.
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25
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Burlingame GM, Seaman S, Johnson JE, Whipple J, Richardson E, Rees F, Earnshaw D, Spencer R, Payne M, O'Neil B. Sensitivity to change of the Brief Psychiatric Rating Scale-Extended (BPRS-E): An item and subscale analysis. Psychol Serv 2006. [DOI: 10.1037/1541-1559.3.2.77] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Brown GS, Jones ER. Implementation of a feedback system in a managed care environment: What are patients teaching us? J Clin Psychol 2005; 61:187-98. [PMID: 15609353 DOI: 10.1002/jclp.20110] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Lessons about patient treatment response from a large-scale outcomes management project are summarized. More than 7,000 clinicians contributed outcome data. Overall, the data demonstrated that patients who have clinical levels of psychological distress and impairment showed a relatively rapid response to treatment. Furthermore, although it appears that the duration and intensity of treatment vary widely from case to case, clinicians and patients make sound judgments as to how much and what kind of treatment is appropriate. Results supported the conclusion that the most effective method to manage costs is to ensure that each patient receive effective care. There are large and stable differences in the effectiveness of clinicians, and outcomes can be improved by referring patients to effective clinicians. The data also suggested that patients who had a poor initial response to treatment eventually had positive outcomes, provided that they remained engaged in treatment. This finding suggests that outcomes can be improved by identifying at-risk patients and proactively keeping them engaged in treatment.
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Affiliation(s)
- George S Brown
- Center for Clinical Informatics, Salt Lake City, UT 84112, USA.
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27
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Dunn TW, Burlingame GM, Walbridge M, Smith J, Crum MJ. Outcome assessment for children and adolescents: psychometric validation of the Youth Outcome Questionnaire 30.1 (Y-OQ®-30.1). Clin Psychol Psychother 2005. [DOI: 10.1002/cpp.461] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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28
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Brown GSJ, Hermann R, Jones E, Wu J. Using Self-Report to Improve Substance Abuse Risk Assessment in Behavioral Health Care. ACTA ACUST UNITED AC 2004; 30:448-54. [PMID: 15357135 DOI: 10.1016/s1549-3741(04)30051-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Primary care and behavioral health clinicians frequently fail to detect substance-related problems among their patients, thereby leading to increased morbidity and mortality and health care costs. A managed behavioral health care organization(MBHO) conducted a quality improvement initiative in which clients seeking outpatient psychotherapy were screened by self-report for substance-related problems, and clinicians were provided with feedback in cases of discrepant findings. METHOD Client self-report questionnaires, which included items inquiring regarding problems related to substance abuse, were administered at multiple points during treatment episodes. Clinicians were also asked to complete assessments, including indicating the presence of a substance abuse problem. RESULTS Clinicians failed to identify substance abuse problems in > 80% of the cases where the patient endorsed items clearly related to substance abuse on the outcome questionnaire. In the quality improvement intervention, the MBHO sent letters alerting clinicians to the clients' self-reported substance abuse problems. The concordance between clinician assessment and client self-reported problems then increased significantly. DISCUSSION Results of the study argue for the utility of using client self-report measures as part of a comprehensive effort to measure and improve the effectiveness of behavioral health care treatment services.
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Affiliation(s)
- G S Jeb Brown
- Center for Clinical Informatics, Salt Lake City, USA.
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29
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The Dose-Response Relationship at a College Counseling Center. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2004. [DOI: 10.1300/j035v18n02_03] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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30
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Percevic R, Lambert MJ, Kordy H. Computer-supported monitoring of patient treatment response. J Clin Psychol 2004; 60:285-99. [PMID: 14981792 DOI: 10.1002/jclp.10264] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The use of information technology (IT) for the purpose of improving psychotherapy outcomes in the context of routine clinical practice is described. IT efforts from two research programs, one in Germany and the other in the United States, are based on evidence that not all patients who enter treatment have a positive outcome and that continuous monitoring of patient treatment response with immediate feedback to therapists can be used to increase the likelihood of success for the poorly responding client. Such monitoring and feedback can best be accomplished by IT methodologies. Suitable IT systems are described, and their strengths and limitations are highlighted. Evidence is presented that supports the positive value of such efforts for improving patient treatment response.
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31
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Brown G, Jones ER, Betts E, Wu J. Improving Suicide Risk Assessment in a Managed-Care Environment. CRISIS 2003. [DOI: 10.1027//0227-5910.24.2.49] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Summary: This article describes the quality improvement intervention of a managed behavioral healthcare company to improve the quality of suicide risk assessments by its panel of providers. At-risk cases are identified by the patient's self-reported high frequency of suicidal ideation on a standardized outcome measure. Clinicians also assess severity of suicidal ideation based on clinical interviews. The clinician's assessment is identified as probably erroneous if the patient report indicates a high frequency of suicidal ideation and the clinicians assessment of suicidal ideation is none. The article describes the methods used to encourage clinicians to utilize information from the patient self-report measure as part of the clinical assessment. Probable suicidal ideation assessment errors were subsequently reduced by 29% over a 1-year period of administration.
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Affiliation(s)
- G.S. Brown
- Center for Clinical Informatics, LLC, Salt Lake City, UT, USA
| | | | - Ellen Betts
- PacifiCare Behavioral Health, Van Nuys, CA, USA
| | - Jingyang Wu
- Center for Clinical Informatics, LLC, Salt Lake City, UT, USA
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32
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Lambert MJ, Whipple JL, Hawkins EJ, Vermeersch DA, Nielsen SL, Smart DW. Is It Time for Clinicians to Routinely Track Patient Outcome? A Meta-Analysis. ACTA ACUST UNITED AC 2003. [DOI: 10.1093/clipsy.bpg025] [Citation(s) in RCA: 165] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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33
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Whipple JL, Lambert MJ, Vermeersch DA, Smart DW, Nielsen SL, Hawkins EJ. Improving the effects of psychotherapy: The use of early identification of treatment and problem-solving strategies in routine practice. J Couns Psychol 2003. [DOI: 10.1037/0022-0167.50.1.59] [Citation(s) in RCA: 214] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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34
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Brown TG, Topp J, Ross D. Rationales, obstacles and strategies for local outcome monitoring systems in substance abuse treatment settings. J Subst Abuse Treat 2003; 24:31-42. [PMID: 12646328 DOI: 10.1016/s0740-5472(02)00342-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The need for outcome monitoring systems (OMS) in substance abuse treatment is now such a pervasive position that it has achieved 'motherhood' stature. Yet, for a variety of reasons, implementation of systematic, ongoing monitoring continues to lag in most settings. The position taken in this article is that a local approach to monitoring is a viable alternative to large scale monitoring programs when such programs are unavailable. Moreover, local OMS can supplement these more generic programs by providing data that are more in tune with the orientation and program development of a specific setting. This article argues that local OMS can be developed with a reorganization of customary documentation procedures, a modest investment of personnel and specialized technical resources, a shorter-term view to outcome, and a commitment to evidence-based treatment.
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Affiliation(s)
- Thomas G Brown
- Pavillon Foster Addiction Treatment Center, St Philippe de LaPrairie, QC J0L 2X0, Canada.
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35
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Abstract
In a variety of clinical settings, computers are playing an increasing role in managing or retrieving clinical information. A recent survey of physician computer use suggests that psychiatrists, in comparison to other types of medical specialists, may be using computers less in routine care. In this paper, we present a literature review of 57 articles on computer programs in psychiatry that were published since 1966 in five major peer-reviewed journals. We divide the types of programs that have been developed into four categories: (1) diagnostic and decision support, (2) patient screening and therapy, (3) data collection and management, and (4) data modeling. Among the first three categories, we found trends in publications during the past three decades of research. We provide a discussion of representative computer programs. Our analysis of past programs reveals a number of design problems that may be a barrier to the more widespread use of computers in psychiatry.
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Affiliation(s)
- Amar K Das
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, New York 10032, USA.
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