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Bennebroek Evertsz' F, Bockting CL, Braamse A, van Dissel MNM, Duijvestein M, Kager LM, Kool M, Löwenberg M, Mares W, Nieuwkerk P, Sipkema HA, Young Z, Knoop H. Implementation of 'IBD-Specific Cognitive Behavioural Therapy' for Patients with Inflammatory Bowel Diseases with Poor Mental Quality of Life, Anxiety and Depression. J Clin Psychol Med Settings 2024; 31:258-278. [PMID: 38281306 DOI: 10.1007/s10880-023-09996-8] [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] [Accepted: 12/04/2023] [Indexed: 01/30/2024]
Abstract
This paper describes the implementation of inflammatory bowel disease (IBD)-specific cognitive behavioural therapy (CBT) for IBD patients with poor quality of life (QoL), anxiety and depression, in four hospitals in the Netherlands. Treatment outcomes were compared with those of a previously published randomized control trial (RCT) of 'IBD-specific CBT', following a benchmark strategy. Primary outcome was IBD-specific QoL (IBDQ) completed before and after CBT, secondary outcomes were anxiety and depressive symptoms (HADS, CES-D). Semi-structured interviews were conducted among a pilot of gastroenterologists, nurse specialists and psychologists to evaluate 'IBD-specific CBT'. 94 patients started treatment (280 screened). At follow-up, 63 participants (67% compared to 81% in the RCT benchmark) completed the IBDQ. Treatment effect sizes of the implementation study were comparable and slightly larger than those of RCT benchmark. Gastroenterologists, IBD nurses and psychologists found CBT necessary for IBD patients with poor QoL, depression and/or anxiety disorders. 'IBD-specific CBT' can be successfully implemented. Regular supervision of psychologists performing 'IBD-specific CBT' treatment is needed.
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Affiliation(s)
- Floor Bennebroek Evertsz'
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands.
| | - Claudi L Bockting
- Department of Psychiatry, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Annemarie Braamse
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Mafalda N M van Dissel
- Medicine Master's Student, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Marjolijn Duijvestein
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Liesbeth M Kager
- Department of Gastroenterology and Hepatology, Noord-West Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Marianne Kool
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Wout Mares
- Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Houkje A Sipkema
- Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, The Netherlands
| | - Zwanet Young
- Brain and Cognitive Sciences Master's Student, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
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Teh KKJ, Ng YK, Doshi K, Tay SW, Hao Y, Ang LY, Foong HLY, Ong AML, Siah KTH, Chan WPW, Ong WC, Mesenas SJ, Lim CH, Wang YT. Mindfulness-based cognitive therapy in functional dyspepsia: A pilot randomized trial. J Gastroenterol Hepatol 2021; 36:2058-2066. [PMID: 33373492 DOI: 10.1111/jgh.15389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/13/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Patients with functional dyspepsia (FD) often have concomitant anxiety and depression. Mindfulness-based cognitive therapy (MBCT) combines the principles of cognitive behavioral therapy and mindfulness. It is a group-based therapy and has been shown to be efficacious in functional gastrointestinal disorders. There are no randomized controlled trials (RCTs) evaluating MBCT in FD. We aimed to evaluate feasibility and efficacy of MBCT in FD management. METHODS We performed a mixed-method single-center pilot randomized trial of 28 patients fulfilling ROME-III criteria for FD. Fifteen patients were randomized to an 8-week MBCT program while 13 underwent treatment-as-usual (TAU). Patients completed questionnaires at baseline and at week 8. Two focus-groups were conducted. Feasibility of recruitment, acceptability of randomization, procedures and intervention, handout compliance and feasibility of quantitative measures were assessed. The primary outcome was subjective-clinical-assessment of FD symptoms (SCA-FD). Secondary outcome measures included Short-form Nepean Dyspepsia Index (SF-NDI), subjective-clinical-assessment of general health (SCA-GH), EuroQoL-Visual Analog Scale (EuroQoL-VAS), and Depression, Anxiety and Stress Scale-21 Items (DASS-21). RESULTS Twelve of 15 patients in the MBCT group completed the program. There was a trend towards symptom improvement, with 90% in the MBCT group reporting improvement in SCA-FD compared with 45% in TAU(P = 0.063). Patients who underwent MBCT reported greater improvement in SF-NDI (mean change: -8.8 (SD: 7.5) vs -0.7 (7.2), P = 0.018) and DASS-21 (-19.8 (29.5) vs -5.5 (6.6) P = 0.13) compared with TAU. There was no difference in SCA-GH and EuroQoL-VAS. Based on SCA-FD improvement, the eventual RCT will require 50 patients (25 in each group). CONCLUSIONS Mindfulness-based cognitive therapy is likely efficacious for FD, and it would be feasible to conduct a RCT.
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Affiliation(s)
- Kevin Kim-Jun Teh
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Yi-Kang Ng
- Department of General Medicine, Sengkang General Hospital, Singapore
| | - Kinjal Doshi
- Department of Psychology, Singapore General Hospital, Singapore
| | - Shu-Wen Tay
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Ying Hao
- Health Services Research Centre, Singapore Health Services, Singapore
| | - Lui-Yee Ang
- Behavioral Medicine Unit, Singapore General Hospital, Singapore
| | | | - Andrew Ming-Liang Ong
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Kewin Tien-Ho Siah
- Department of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, The National University of Singapore, Singapore
| | - Webber Pak-Wo Chan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Wai-Choung Ong
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Steven Joseph Mesenas
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Chee-Hooi Lim
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Yu-Tien Wang
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
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Hamm RF, Iriye BK, Srinivas SK. Implementation Science is Imperative to the Optimization of Obstetric Care. Am J Perinatol 2021; 38:643-648. [PMID: 33321535 PMCID: PMC9268067 DOI: 10.1055/s-0040-1721728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In an effort aimed at improving outcomes, obstetric teams have enacted comprehensive care bundles and other clinical tools. Yet, these practices have had limited degrees of success on a national scale. Implementation science aims to bridge the divide between the development of evidence-based interventions and their real-world utilization. This emerging field takes into account key stakeholders at the clinician, institution, and health policy levels. Implementation science evaluates how well an intervention is or can be delivered, to whom, in which context, and how it may be up-scaled and sustained. Other medical disciplines have embraced these concepts with success. The frameworks and theories of implementation science can and should be incorporated into both obstetric research and practice. By doing so, we can increase widespread and timely adoption of evidence and further our common goal of decreasing maternal morbidity and mortality. KEY POINTS: · Evidence-based practices have been implemented in obstetrics with variable success.. · Implementation science aims to bridge the divide between the development of evidence-based interventions and their real-world utilization.. · The methodologies of implementation science may be helpful to obstetric research and practice..
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Affiliation(s)
- Rebecca F. Hamm
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Sindhu K. Srinivas
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Jones M, Råbu M, Røssberg JI, Ulberg R. Therapists' Experiences of Psychodynamic Therapy with and without Transference Interventions for Adolescents with Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134628. [PMID: 32605079 PMCID: PMC7370027 DOI: 10.3390/ijerph17134628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 01/07/2023]
Abstract
Psychodynamic therapy is an effective treatment for depression. However, a large number of adolescent patients with depression do not respond and/or drop out of therapy and little is known about what therapists actually do in therapy with adolescents. Thus, more research is needed to explore the various actions that therapists do in therapy, so that therapists can tailor their therapy more specifically to each individual adolescent. The present study aimed to investigate how the experience of psychotherapists differs between two treatment modes for adolescents with depression: psychodynamic psychotherapy with and without transference interventions. In-depth interviews were conducted with six therapists. The data, which were analyzed using thematic analysis, generated three key themes: (1) The therapists experienced that transference interventions are often useful in therapies with adolescents with depression, (2) therapies without transference interventions can be challenging for therapists, but still helpful for patients, and (3) the experience contributed to the deepening recognition of therapists that they always need to adapt their techniques to the particular patient. The results enhance our knowledge of the significance of therapists’ actions in therapy with adolescents. The therapists highlighted issues that are important for identifying barriers to incorporating new knowledge into clinical practice.
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Affiliation(s)
- Maria Jones
- Department of Psychology, University of Oslo, Pb. 1094 Blindern, 0317 Oslo, Norway;
- Correspondence: ; Tel.: +47-924-21-358
| | - Marit Råbu
- Department of Psychology, University of Oslo, Pb. 1094 Blindern, 0317 Oslo, Norway;
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway;
- Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway;
| | - Randi Ulberg
- Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway;
- Department of Psychiatry, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
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5
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Westerlund A, Ivarsson A, Richter-Sundberg L. Evidence-based practice in child and adolescent mental health services - The challenge of implementing national guidelines for treatment of depression and anxiety. Scand J Caring Sci 2020; 35:476-484. [PMID: 32323362 DOI: 10.1111/scs.12859] [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] [Received: 09/04/2019] [Accepted: 03/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mental health problems are one of the most pressing public health concerns of our time. Sweden has seen a sharp increase in mental disorders among children and youth during the last decade. The evidence base for treatment of psychiatric conditions has developed strongly. Clinical practice guidelines aim to compile such evidence and support healthcare professionals in evidence-based clinical decision-making. In Sweden, the national guidelines for the treatment of depression and anxiety disorders in children and adolescents were launched in 2010. The aim of this study was two folded, (i) to explore to what extent these guidelines were known and adhered to by health professionals in Child and Adolescent Mental Health Services and (ii) to investigate factors influencing implementation of the guidelines informed by the Consolidated Framework for Implementation Research. METHODS A qualitative approach was used, and data were collected through interviews with 18 health professionals in Child Mental Health Services in Sweden and a combination of conventional and directed content analyses was used. The Consolidated Framework for Implementation Research guided and structured data collection and analysis. RESULTS The guidelines were largely unknown by health professionals in Child Mental Health Services in all the clinics investigated. Adherence to guideline recommendations was reported as very low. Barriers to implementation were found in relation to the characteristics of the intervention, outer setting, inner setting and characteristics of the individuals involved. CONCLUSIONS The government initiative to develop and disseminate the guidelines seems to have made very little impact on health professionals' clinical practice. The guidelines were poorly aligned with the health professionals' knowledge and beliefs about effective mental health services for children and youth with depression and anxiety disorders. Suggestions for future efforts to improve the development and implementation of guidelines in Child Mental Health Services settings are given.
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Affiliation(s)
- Anna Westerlund
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Linda Richter-Sundberg
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Department of Clinical Science, Unit of Child and Adolescent Psychiatry, Umeå University, Umeå, Sweden
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Gan DZQ, Zhou Y, Hoo E, Chong D, Chu CM. The Implementation of Functional Family Therapy (FFT) as an Intervention for Youth Probationers in Singapore. JOURNAL OF MARITAL AND FAMILY THERAPY 2019; 45:684-698. [PMID: 30191586 PMCID: PMC7379917 DOI: 10.1111/jmft.12353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Family functioning is predictive of youth recidivism in Singapore. However, there is a lack of family based interventions for youth offenders on community probation. Evidence-based family interventions developed in Western populations, such as Functional Family Therapy (FFT), have been found to be effective in mitigating subsequent youth criminal behavior. However, no study has examined whether such interventions can be implemented and adapted for use in Eastern cultures. Thus, this paper sought to detail the implementation of FFT in Singapore. Rationale for the adoption of FFT is discussed, and key activities undertaken during the first 18 months of implementation are described. Preliminary data suggest that initial implementation efforts were successful. Challenges encountered, and implications in relation to the broader literature are discussed.
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Affiliation(s)
- Daniel Z. Q. Gan
- Clinical and Forensic Psychology ServiceMinistry of Social and Family Development
| | - Yiwei Zhou
- Clinical and Forensic Psychology ServiceMinistry of Social and Family Development
| | - Eric Hoo
- Clinical and Forensic Psychology ServiceMinistry of Social and Family Development
| | - Dominic Chong
- Clinical and Forensic Psychology ServiceMinistry of Social and Family Development
| | - Chi Meng Chu
- Clinical and Forensic Psychology ServiceMinistry of Social and Family Development
- Centre for Research on Rehabilitation and ProtectionMinistry of Social and Family Development
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7
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Kilbourne AM, Smith SN, Choi SY, Koschmann E, Liebrecht C, Rusch A, Abelson JL, Eisenberg D, Himle JA, Fitzgerald K, Almirall D. Adaptive School-based Implementation of CBT (ASIC): clustered-SMART for building an optimized adaptive implementation intervention to improve uptake of mental health interventions in schools. Implement Sci 2018; 13:119. [PMID: 30185192 PMCID: PMC6126013 DOI: 10.1186/s13012-018-0808-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022] Open
Abstract
Background Depressive and anxiety disorders affect 20–30% of school-age youth, most of whom do not receive adequate services, contributing to poor developmental and academic outcomes. Evidence-based practices (EBPs) such as cognitive behavioral therapy (CBT) can improve outcomes, but numerous barriers limit access among affected youth. Many youth try to access mental health services in schools, but school professionals (SPs: counselors, psychologists, social workers) are rarely trained adequately in CBT methods. Further, SPs face organizational barriers to providing CBT, such as lack of administrative support. Three promising implementation strategies to address barriers to school-based CBT delivery include (1) Replicating Effective Programs (REP), which deploys customized CBT packaging, didactic training in CBT, and technical assistance; (2) coaching, which extends training via live supervision to improve SP competence in CBT delivery; and (3) facilitation, which employs an organizational expert who mentors SPs in strategic thinking to promote self-efficacy in garnering administrative support. REP is a relatively low-intensity/low-cost strategy, whereas coaching and facilitation require additional resources. However, not all schools will require all three strategies. The primary aim of this study is to compare the effectiveness of a school-level adaptive implementation intervention involving REP, coaching, and facilitation versus REP alone on the frequency of CBT delivered to students by SPs and student mental health outcomes. Secondary and exploratory aims examine cost-effectiveness, moderators, and mechanisms of implementation strategies. Methods Using a clustered, sequential multiple-assignment, randomized trial (SMART) design, ≥ 200 SPs from 100 schools across Michigan will be randomized initially to receive REP vs. REP+coaching. After 8 weeks, schools that do not meet a pre-specified implementation benchmark are re-randomized to continue with the initial strategy or to augment with facilitation. Discussion EBPs need to be implemented successfully and efficiently in settings where individuals are most likely to seek care in order to gain large-scale impact on public health. Adaptive implementation interventions hold the promise of providing cost-effective implementation support. This is the first study to test an adaptive implementation of CBT for school-age youth, at a statewide level, delivered by school staff, taking an EBP to large populations with limited mental health care access. Trial registration NCT03541317—Registered on 29 May 2018 on ClinicalTrials.gov PRS Electronic supplementary material The online version of this article (10.1186/s13012-018-0808-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy M Kilbourne
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA. .,U.S. Department of Veterans Affairs, Quality Enhancement Research Initiative, Washington D.C., USA.
| | - Shawna N Smith
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Seo Youn Choi
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Elizabeth Koschmann
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Celeste Liebrecht
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Amy Rusch
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James L Abelson
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel Eisenberg
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joseph A Himle
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Kate Fitzgerald
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel Almirall
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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8
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Damian AJ, Gallo J, Leaf P, Mendelson T. Organizational and provider level factors in implementation of trauma-informed care after a city-wide training: an explanatory mixed methods assessment. BMC Health Serv Res 2017; 17:750. [PMID: 29157241 PMCID: PMC5696731 DOI: 10.1186/s12913-017-2695-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 11/07/2017] [Indexed: 11/18/2022] Open
Abstract
Background While there is increasing support for training youth-serving providers in trauma-informed care (TIC) as a means of addressing high prevalence of U.S. childhood trauma, we know little about the effects of TIC training on organizational culture and providers’ professional quality of life. This mixed-methods study evaluated changes in organizational- and provider-level factors following participation in a citywide TIC training. Methods Government workers and nonprofit professionals (N = 90) who participated in a nine-month citywide TIC training completed a survey before and after the training to assess organizational culture and professional quality of life. Survey data were analyzed using multiple regression analyses. A subset of participants (n = 16) was interviewed using a semi-structured format, and themes related to organizational and provider factors were identified using qualitative methods. Results Analysis of survey data indicated significant improvements in participants’ organizational culture and professional satisfaction at training completion. Participants’ perceptions of their own burnout and secondary traumatic stress also increased. Four themes emerged from analysis of the interview data, including “Implementation of more flexible, less-punitive policies towards clients,” “Adoption of trauma-informed workplace design,” “Heightened awareness of own traumatic stress and need for self-care,” and “Greater sense of camaraderie and empathy for colleagues.” Conclusion Use of a mixed-methods approach provided a nuanced understanding of the impact of TIC training and suggested potential benefits of the training on organizational and provider-level factors associated with implementation of trauma-informed policies and practices. Future trainings should explicitly address organizational factors such as safety climate and morale, managerial support, teamwork climate and collaboration, and individual factors including providers’ compassion satisfaction, burnout, and secondary traumatic stress, to better support TIC implementation.
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Affiliation(s)
- April Joy Damian
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway Street, 8th Floor, Baltimore, MD, 21205, USA.
| | - Joseph Gallo
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway Street, 8th Floor, Baltimore, MD, 21205, USA
| | - Philip Leaf
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway Street, 8th Floor, Baltimore, MD, 21205, USA
| | - Tamar Mendelson
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway Street, 8th Floor, Baltimore, MD, 21205, USA
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Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 42:533-44. [PMID: 24193818 DOI: 10.1007/s10488-013-0528-y] [Citation(s) in RCA: 2885] [Impact Index Per Article: 360.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purposeful sampling is widely used in qualitative research for the identification and selection of information-rich cases related to the phenomenon of interest. Although there are several different purposeful sampling strategies, criterion sampling appears to be used most commonly in implementation research. However, combining sampling strategies may be more appropriate to the aims of implementation research and more consistent with recent developments in quantitative methods. This paper reviews the principles and practice of purposeful sampling in implementation research, summarizes types and categories of purposeful sampling strategies and provides a set of recommendations for use of single strategy or multistage strategy designs, particularly for state implementation research.
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Affiliation(s)
- Lawrence A Palinkas
- School of Social Work, University of Southern California, 669 W. 34th Street, Los Angeles, CA, 90089-0411, USA,
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10
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Owczarzak J, Broaddus M, Pinkerton S. A qualitative analysis of the concepts of fidelity and adaptation in the implementation of an evidence-based HIV prevention intervention. HEALTH EDUCATION RESEARCH 2016; 31:283-94. [PMID: 26944867 PMCID: PMC5007579 DOI: 10.1093/her/cyw012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/03/2016] [Indexed: 05/26/2023]
Abstract
Continued debate about the relative value of fidelity versus adaptation, and lack of clarity about the meaning of fidelity, raise concerns about how frontline service providers resolve similar issues in their daily practice. We use SISTA ('Sisters Informing Sisters on Topics about acquired immune deficiency syndrome'), an evidence-based human immunodeficiency virus (HIV) prevention intervention for African American women, to understand how facilitators and program directors interpret and enact implementation fidelity with the need for adaptation in real-world program delivery. We conducted 22 in-depth, semi-structured interviews with service providers from four agencies implementing SISTA. Facilitators valued their skills as group leaders and ability to emotionally engage participants as more critical to program effectiveness than delivering the intervention with strict fidelity. Consequently, they saw program manuals as guides rather than static texts that should never be changed and, moreover, viewed the prescriptive nature of manuals as undermining their efforts to fully engage with participants. Our findings suggest that greater consideration should be given to understanding the role of facilitators in program effectiveness over and above the question of whether they implement the program with fidelity. Moreover, training curricula should provide facilitators with transferable skills through general facilitator training rather than only program-specific or manual-specific training.
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Affiliation(s)
- Jill Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, 624 N. Broadway, Hampton House Room 739, Baltimore, MD 21205-1996 and
| | - Michelle Broaddus
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI 53202
| | - Steven Pinkerton
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI 53202
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Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015. [PMID: 24193818 DOI: 10.1007/s10488-013-0528-y.purposeful] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Purposeful sampling is widely used in qualitative research for the identification and selection of information-rich cases related to the phenomenon of interest. Although there are several different purposeful sampling strategies, criterion sampling appears to be used most commonly in implementation research. However, combining sampling strategies may be more appropriate to the aims of implementation research and more consistent with recent developments in quantitative methods. This paper reviews the principles and practice of purposeful sampling in implementation research, summarizes types and categories of purposeful sampling strategies and provides a set of recommendations for use of single strategy or multistage strategy designs, particularly for state implementation research.
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Affiliation(s)
- Lawrence A Palinkas
- School of Social Work, University of Southern California, 669 W. 34th Street, Los Angeles, CA, 90089-0411, USA,
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12
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MacPherson HA, Leffler JM, Fristad MA. Implementation of multi-family psychoeducational psychotherapy for childhood mood disorders in an outpatient community setting. JOURNAL OF MARITAL AND FAMILY THERAPY 2014; 40:193-211. [PMID: 24749838 PMCID: PMC4198302 DOI: 10.1111/jmft.12013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Despite advances in evidence-based treatments (EBTs), research suggests these interventions are not utilized in practice settings. This study examined implementation of multi-family psychoeducational psychotherapy (MF-PEP), an EBT for childhood mood disorders, in two outpatient community clinics. Fifteen community therapists facilitated MF-PEP. Twenty community clinicians referred 40 children ages 8-12 with mood disorders and their parents who participated in MF-PEP. Preliminary descriptive findings based on observations and self-report questionnaires demonstrated implementation outcomes of acceptability, adoption, appropriateness, feasibility, implementation cost, penetration, and sustainability of MF-PEP at these clinics. Parents also demonstrated significant improvement in knowledge of mood disorders posttreatment. Preliminary results support implementation of MF-PEP in practice settings and suggest community-based MF-PEP may be associated with improvement in clinical outcomes.
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13
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Powell BJ, Proctor EK, Glass JE. A Systematic Review of Strategies for Implementing Empirically Supported Mental Health Interventions. RESEARCH ON SOCIAL WORK PRACTICE 2014; 24:192-212. [PMID: 24791131 PMCID: PMC4002057 DOI: 10.1177/1049731513505778] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE This systematic review examines experimental studies that test the effectiveness of strategies intended to integrate empirically supported mental health interventions into routine care settings. Our goal was to characterize the state of the literature and to provide direction for future implementation studies. METHODS A literature search was conducted using electronic databases and a manual search. RESULTS Eleven studies were identified that tested implementation strategies with a randomized (n = 10) or controlled clinical trial design (n = 1). The wide range of clinical interventions, implementation strategies, and outcomes evaluated precluded meta-analysis. However, the majority of studies (n = 7; 64%) found a statistically significant effect in the hypothesized direction for at least one implementation or clinical outcome. CONCLUSIONS There is a clear need for more rigorous research on the effectiveness of implementation strategies, and we provide several suggestions that could improve this research area.
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Zagustin TK. The Role of Cognitive Behavioral Therapy for Chronic Pain in Adolescents. PM R 2013; 5:697-704. [DOI: 10.1016/j.pmrj.2013.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 05/17/2013] [Indexed: 11/29/2022]
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A Pilot Study Disseminating Cognitive Behavioral Therapy for Depression: Therapist Factors and Perceptions of Barriers to Implementation. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2011; 38:324-34. [DOI: 10.1007/s10488-011-0348-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Palinkas LA, Aarons GA, Horwitz S, Chamberlain P, Hurlburt M, Landsverk J. Mixed method designs in implementation research. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2011; 38:44-53. [PMID: 20967495 PMCID: PMC3025112 DOI: 10.1007/s10488-010-0314-z] [Citation(s) in RCA: 577] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper describes the application of mixed method designs in implementation research in 22 mental health services research studies published in peer-reviewed journals over the last 5 years. Our analyses revealed 7 different structural arrangements of qualitative and quantitative methods, 5 different functions of mixed methods, and 3 different ways of linking quantitative and qualitative data together. Complexity of design was associated with number of aims or objectives, study context, and phase of implementation examined. The findings provide suggestions for the use of mixed method designs in implementation research.
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Affiliation(s)
- Lawrence A Palinkas
- School of Social Work, University of Southern California, Los Angeles, CA 90089-0411, USA.
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Hurlburt MS, Garland AF, Nguyen K, Brookman-Frazee L. Child and family therapy process: concordance of therapist and observational perspectives. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2010; 37:230-44. [PMID: 19902347 PMCID: PMC2877358 DOI: 10.1007/s10488-009-0251-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The objective of this study is to examine the characteristics of outpatient mental health services delivered in community-based outpatient clinics, comparing information obtained from two different sources, therapists serving children and families, and observational coders viewing tapes of the same treatment sessions. Videotaped therapy sessions were rated by therapists and independent coders regarding goals and strategies pursued during each session. Sixty-three sessions were taped of outpatient care provided to 18 children and their caregivers by 11 therapists. Children were 4-13 years old and families were receiving services at least in part due to reported child behavior problems, confirmed by ratings from the Child Behavior Checklist and Conners Parent Rating Scale-Revised. Analyses assessed the frequency, type, and intensity of goals and strategies pursued in therapy sessions from both therapist and observational coders' perspectives. Reliability of observer ratings and correspondence between therapist and observer reports were also examined. The reliability of observational coding of goals and strategies was moderate to good, with 76% of 39 codes having ICCs of .5 or greater. Therapists reported pursuing 2.5 times more goals and strategies per session, on average, than identified by observational coders. Correspondence between therapists and coders about the occurrence of specific goals and strategies in treatment sessions was low, with 20.5% of codes having a Kappa of .4 or higher. Substantial differences exist in what therapists and independent coders report as occurring in outpatient treatment sessions. Both perspectives suggest major differences between the content of services provided in community-based outpatient clinics and the structure of evidence-based programs, which emphasize intense pursuit of a small number of goals and strategies in each treatment session. Implications of the findings for quality improvement efforts in community-based mental health care settings are discussed.
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Danseco E, Sundar P, Kasprzak S, Witteveen T, Woltman H, Manion I. Are we there yet? Evaluation and the knowledge translation journey. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2009; 18:7-15. [PMID: 19270844 PMCID: PMC2651207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 01/23/2009] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Critical to knowledge translation are organizations' efforts to evaluate their implementation of evidence-based practices (EBPs). Organizations face challenges in their ability to be aware of emerging practices, to measure their efforts against current evidence, and to adapt EBPs to their contextual environments. The Provincial Centre of Excellence for Child and Youth Mental Health has engaged in initiatives to increase the uptake of EBPs and mobilize knowledge by building capacity for evaluation and research in the sector. METHODS Consultation services and innovative grants to organizations with mental health programs and services, where the Centre acts as both knowledge and relationship broker, are contributing to organizations' capacity to do and use evaluation. RESULTS Case exemplars illustrate the processes, successes and challenges experienced by organizations in Centre-supported activities. The Centre's efforts to build organizations' skills in doing and using evaluation, promoting a learning-by-doing approach and fostering collaboration are described. CONCLUSIONS Organizations with the capacity to conduct effective evaluations are better able to implement and assess EBPs, conduct quality evaluations, and contribute to research in the child and youth mental health sector. Widespread gains in mental health organizations' evaluation capacities will contribute to system innovations and the fostering of collaborative partnerships.
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Affiliation(s)
- Evangeline Danseco
- The Provincial Centre of Excellence for Child and Youth Mental Health at CHEO, Ottawa, Ontario.
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