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Johnson C, AlRasheed R, Gray C, Triplett N, Mbwayo A, Weinhold A, Whetten K, Dorsey S. Uncovering determinants of perceived feasibility of TF-CBT through coincidence analysis. IMPLEMENTATION RESEARCH AND PRACTICE 2024; 5:26334895231220277. [PMID: 38322800 PMCID: PMC10775737 DOI: 10.1177/26334895231220277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Introduction A mental health provider's perception of how well an intervention can be carried out in their context (i.e., feasibility) is an important implementation outcome. This article aims to identify determinants of feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) through a case-based causal approach. Method Data come from an implementation-effectiveness study in which lay counselors (teachers and community health volunteers) implemented a culturally adapted manualized mental health intervention, TF-CBT, delivered to teens who were previously orphaned and were experiencing posttraumatic stress symptoms and prolonged grief in Western Kenya. The intervention team identified combinations of determinants that led to feasibility among teacher- and community health volunteer-counselors through coincidence analysis. Results Among teacher-counselors, organizational-level factors (implementation climate, implementation leadership) determined moderate and high levels of feasibility. Among community health volunteer-counselors, a strong relationship between a clinical supervisor and the supervisee was the most influential determinant of feasibility. Conclusion Methodology and findings from this article can guide the assessment of determinants of feasibility and the development of implementation strategies for manualized mental health interventions in contexts like Western Kenya. Plain Language Summary A mental health provider's perception of how easy a therapy is to use in their work setting (i.e., feasibility) can impact whether the provider uses the therapy in their setting. Implementation researchers have recommended finding practices and constructs that lead to important indicators that a therapy will be used. However, limited research to our knowledge has searched and found practices and constructs that might determine feasibility of a therapy. This article uses existing data from a large trial looking at the continued use of a trauma-focused therapy to find practices and constructs that lead to moderate and high levels of feasibility. We found that in settings with a strong organizational structure that organization and leadership support for the therapy led to teachers in Kenya to perceive the therapy as easy to use. On the other hand, in settings with a weaker organizational structure, outside support from a clinical supervisor led to community health volunteers in Kenya perceiving the therapy as easy to use. The findings from this article can guide context-specific recommendations for increasing perceived therapy feasibility at the provider-, organization-, and policy levels.
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Affiliation(s)
- Clara Johnson
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Rashed AlRasheed
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Christine Gray
- Center for Health Policy and Inequities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Noah Triplett
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Andrew Weinhold
- Center for Health Policy and Inequities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Kathryn Whetten
- Center for Health Policy and Inequities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
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Pollak I, Stiehl KAM, Birchwood J, Schrank B, Zechner KA, Wiesner C, Woodcock KA. Promoting Peer Connectedness Through Social-Emotional Learning: Evaluating the Intervention Effect Mechanisms and Implementation Factors of a Social-Emotional Learning Programme for 9 to 12-Year-Olds. J Youth Adolesc 2024; 53:89-116. [PMID: 37796373 PMCID: PMC10761397 DOI: 10.1007/s10964-023-01871-x] [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: 06/21/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
There is little evidence regarding the effect mechanisms of social-emotional learning programs on children's peer relationships. The current study evaluated a novel school-based social-emotional learning program for the first year of secondary school assessing effects on social-emotional skills, peer connectedness, happiness, student and teacher classroom climate. The sample included 19 intervention classrooms (n = 399) and 16 waitlist-control classrooms (n = 281), with a mean age of 10.34 (SD = 0.76) and 48.8% girls. The main intervention effect analysis followed a per-protocol approach and was thus conducted with eight classes that finished all sessions (n = 195) and the control group classes (n = 281). It was further hypothesized that increases in social-emotional skills would predict peer connectedness and class climate increases, which would predict happiness. Results indicated significant intervention effects for social skills, peer connectedness and happiness. Classroom climate declined for both groups, seemingly affected by the school transition. Hypothesized relationships between target variables were partly supported with significant effects of social-emotional skills on connectedness and significant effects of peer connectedness on happiness for children reporting connectedness decreases. Additional analyses were conducted including all classrooms to compare the intervention's effectiveness across different implementation progress groups. Significant group differences were found, indicating that implementation aspects impact intervention outcomes. The findings indicate that universal, school-based social-emotional leaning programs are effective approaches to support peer relationships in the context of the school transition. However, more implementation support seems to be needed to ensure best-practice delivery and achieve maximal intervention effectiveness.
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Affiliation(s)
- Isabella Pollak
- D.O.T. Research Group for Mental Health of Children and Adolescents, Ludwig Boltzmann Society at Karl Landsteiner University of Health Sciences, Krems, Austria.
- Karl Landsteiner University of Health Sciences, Scientific Working Group, D.O.T.-Die offene Tür (The open door), Krems, Austria.
- Centre for Applied Psychology, School of Psychology, University of Birmingham, Birmingham, UK.
- Department of Health and Clinical Psychology, University of Vienna, Vienna, Austria.
| | - Katharina A M Stiehl
- D.O.T. Research Group for Mental Health of Children and Adolescents, Ludwig Boltzmann Society at Karl Landsteiner University of Health Sciences, Krems, Austria
- Karl Landsteiner University of Health Sciences, Scientific Working Group, D.O.T.-Die offene Tür (The open door), Krems, Austria
- Department of Health and Clinical Psychology, University of Vienna, Vienna, Austria
- Karl Landsteiner University of Health Sciences, Research Centre Transitional Psychiatry at the Tulln University Hospital, Krems, Austria
| | - James Birchwood
- School of Education, University of Birmingham, Birmingham, UK
| | - Beate Schrank
- D.O.T. Research Group for Mental Health of Children and Adolescents, Ludwig Boltzmann Society at Karl Landsteiner University of Health Sciences, Krems, Austria
- Karl Landsteiner University of Health Sciences, Scientific Working Group, D.O.T.-Die offene Tür (The open door), Krems, Austria
- Karl Landsteiner University of Health Sciences, Research Centre Transitional Psychiatry at the Tulln University Hospital, Krems, Austria
- Department of Psychiatry, University Hospital Tulln, Tulln an der Donau, Austria
| | - Kerstin Angelika Zechner
- Department of Diversity, University College of Teacher Education in Lower Austria, Baden, Austria
| | - Christian Wiesner
- Department of Diversity, University College of Teacher Education in Lower Austria, Baden, Austria
| | - Kate Anne Woodcock
- Centre for Applied Psychology, School of Psychology, University of Birmingham, Birmingham, UK
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
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Wergeland GJH, Haaland ÅT, Fjermestad KW, Öst LG, Gjestad R, Bjaastad JF, Hoffart A, Husabo E, Raknes S, Haugland BSM. Predictors of school-based cognitive behavior therapy outcome for youth with anxiety. Behav Res Ther 2023; 169:104400. [PMID: 37690362 DOI: 10.1016/j.brat.2023.104400] [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: 12/09/2022] [Revised: 08/08/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
Meta-analyses of school-based CBT have shown that prevention for anxiety symptoms typically report small but significant effects. There is limited knowledge regarding which youths may benefit most and least from such programs, and characteristics of youth who respond differentially to interventions of different intensity. The present study examined predictors of school-based CBT outcomes among 302 youths (mean age 14.0 years, SD 0.8, 84% female) who participated in a randomized waitlist-controlled trial comparing a 10-session and a 5-session group intervention. Potential predictors included youth and parental factors, and credibility and expectancy of the interventions. Pre-intervention anxiety and depression levels, and clinician rated severity were examined as moderators of intervention effects. Outcomes were youth-, and parent-reported youth anxiety and depressive symptoms at post-intervention and 1-year follow-up. Higher parent-reported impairment from youth anxiety predicted larger parent-reported anxiety and depressive symptom change, whereas higher caregiver strain was associated with less symptom change. Higher parent rated credibility and expectancy was associated with improved outcomes at post-intervention. At 1-year follow-up, no predictors of outcome were identified. No moderators were identified. Families with high levels of caregiver strain associated with youth anxiety may need extra support regardless of length of intervention program. Parents' credibility and expectancy of interventions should be targeted to optimize school-based CBT.
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Affiliation(s)
- Gro Janne H Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.
| | - Åshild T Haaland
- Department of Child and Adolescence Mental Health, Sørlandet Hospital, Kristiansand, Norway
| | | | | | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jon F Bjaastad
- Division of Psychiatry, Stavanger University Hospital, Norway
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
| | - Elisabeth Husabo
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Center, NORCE, Norway
| | | | - Bente S M Haugland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Center, NORCE, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway
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Putkuri T, Lahti M, Laaksonen C, Sarvasmaa AS, Huttunen R, Axelin A. Mental health services in the school environment-Future visions using a phenomenographic approach. J Clin Nurs 2023; 32:2742-2756. [PMID: 35599343 DOI: 10.1111/jocn.16376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/18/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES First, to describe the variation in stakeholders' perceptions related to the desirable mental health services in school environments. Second, to construct alternative future visions based on these perceptions. Finally, to describe stakeholders' perceptions about the actions needed to reach such an ideal state. BACKGROUND The increased need for mental health care has challenged the role of schools and school health care in the area of mental health services for those of school-age. There is a need for future visions and comprehensive statements concerning the mental health services provided in the school environment. DESIGN The study was undertaken in Finland, between February 2020 and February 2021. Qualitative individual interviews were conducted with 15 professional stakeholders and focus group interviews with 10 stakeholders advocating for adolescents or parents. METHOD The study was conducted with the phenomenographic approach using a visioning methodology. The study is reported following the COREQ checklist. RESULT Four alternative future visions were formulated based on the perceptions of the stakeholders. They emphasised different aspects: (1) non-medicalising the school environment, (2) early and extensive intervention by school nurses enabled by work distribution with mental health specialists, (3) a multiprofessional team providing help on overall health questions and (4) a focusing of the services on mental disorders. Necessary changes were identified at the micro-, mezzo- and macro-level. CONCLUSION The future visions are based on opposite perceptions related to the mission and focus of school health care. One extreme emphasises overall health promotion for everyone, while the other accentuates treatment for those suffering from mental disorders. The former may lead to inadequate help for mental health problems and the latter insufficient help for other health problems. RELEVANCE TO CLINICAL PRACTICE This study contributes alternative future visions, promotes strategic planning and helps to clarify the future role of school nurses.
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Affiliation(s)
- Tiina Putkuri
- Department of Nursing Science, University of Turku, Turku, Finland
- Laurea University of Applied Science, Vantaa, Finland
| | - Mari Lahti
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University of Applied Science, Turku, Finland
| | | | - Anna S Sarvasmaa
- Finnish Student Health Service, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Rauno Huttunen
- Department of Education, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
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Conroy K, Salem H, Georgiadis C, Hong N, Herrera A, Furr JM, Greif Green J, Comer JS. Gauging Perceptions and Attitudes About Student Anxiety and Supports Among School-Based Providers. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09470-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Treatment Fidelity in Brief Versus Standard-Length School-Based Interventions for Youth with Anxiety. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09458-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractTo examine treatment fidelity in a randomized controlled trial of indicated school-based cognitive-behavioral therapy (CBT) delivered in groups to youth with anxiety. We investigated whether adherence and competence (a) differed across brief and standard-length CBT, and (b) if adherence and competence predicted change in anxiety symptoms and impairment. Method: Sessions were observationally coded with the Competence and Adherence Scale for CBT for Anxiety Disorders in Youth. Coders (N = 7) rated 104 sessions from 52 groups delivered by 32 facilitators (M age = 43.2 years, SD = 8.1) to 295 youth (M age = 14.0 years, SD = 0.8). Outcomes were youth- and parent-reported anxiety symptoms and impairment at post-intervention and 1-year follow-up. Linear mixed effect models were used to analyze whether fidelity predicted clinical outcomes. Results: Levels of adherence and competence were adequate in both programs, but higher in brief compared to standard-length CBT p < .001 and p = .010, respectively). Neither adherence nor competence predicted clinical outcomes at any timepoints. Conclusion: Higher levels of adherence and competence in brief CBT suggest that it may be easier for novice CBT providers to achieve fidelity in simplified and less flexible interventions. Contrary to expectation, adherence and competence did not predict clinical outcomes.
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