RESUMO
This study examined patterns and predictors of 79 public sector therapists' practice element (PE) intentions for treating hypothetical single problem area youth with either anxiety or disruptive behavior problems. Analyses of intention profiles suggested that PE intentions varied by diagnosis and included both a majority of practices derived from the evidence base (PDEBs) and a large number of practices with minimal evidence support (PMESs) for each problem area. Hierarchical multiple regression results indicated the only significant predictor of higher PDEB intentions for both problem areas was reporting more PMES intentions. Implications for community-based research and implementation efforts are discussed.
Assuntos
Serviços Comunitários de Saúde Mental , Comportamento Problema , Adolescente , Transtornos de Ansiedade , Prática Clínica Baseada em Evidências , Humanos , IntençãoRESUMO
Youth psychosocial treatments have proliferated over many decades and the time is ripe to examine the unique contribution of these treatments. Six hundred eighty-nine randomized clinical trials were examined from the PracticeWise Evidence-Based Services Database, an ongoing data source of youth psychosocial literature. A number of studies, treatment protocols, and practice elements across 11 youth problem areas (e.g., anxiety) from 1966 to 2016 are provided. Using distillation methodology, we compared the relationship between new treatment protocols and the identification of new practice elements within each problem area over time. Anxiety, disruptive behavior, attention/hyperactivity, and depression were the most studied problem areas, whereas suicide, eating disorders, and mania were least studied. While identification of new practice elements leveled off, studies continued to increase over time. For some problem areas, unique practice elements have not been identified for over a decade. Future studies examining treatment innovation and implications for behavioral health are discussed.
Assuntos
Transtornos Mentais/terapia , Adolescente , Criança , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
This study examined the psychometric properties of the Intention Scale for Providers-Direct Items (ISP-D; 16 items), a questionnaire for assessing therapists' evidence-based practice attitudes, subjective norms, perceived behavioral control, and behavioral intentions. Participants were community mental health providers from the State of Hawaii. A confirmatory factor analysis provided support for a revised 14-item ISP-D measure that fits the data reasonably well. Subscales of this revised ISP-D demonstrated acceptable to good internal consistency, with the exception of the Perceived Behavioral Control subscale. The majority of convergent validity correlation patterns between the ISP-D and related constructs were significant and in predicted directions.
Assuntos
Atitude do Pessoal de Saúde , Prática Clínica Baseada em Evidências/normas , Intenção , Teoria Psicológica , Psicometria/estatística & dados numéricos , Inquéritos e Questionários/normas , Serviços Comunitários de Saúde Mental/organização & administração , Análise Fatorial , Havaí , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Reprodutibilidade dos TestesRESUMO
Over the past several years, youth treatment research has moved toward understanding the dissemination and implementation of evidence-based practices (EBPs). As a result, studies have focused on identifying predictors that aid in successful adoption and sustainment of EBPs. Theories of behavior change posit that therapist knowledge and attitudes play a fundamental role in EBP adoption; however, studies have produced mixed findings, which may be an artifact of broad definitions of both EBP knowledge and EBP itself. The current study was an examination of 46 youth community therapists and the extent to which varying types of knowledge and attitudes as well as youth characteristics predicted specific practices derived from the evidence-base. Results suggested that specific EBP knowledge predicted specific practices, highlighting the need for more specificity when examining predictors of EBP use. Therapists' attitudes, demographic characteristics, and youth characteristics were also significant predictors of EBP use. Future research should consider examining discrete and specific practices to better understand and predict therapists' future behavior.
Assuntos
Atitude do Pessoal de Saúde , Terapia Comportamental/organização & administração , Serviços Comunitários de Saúde Mental/organização & administração , Prática Clínica Baseada em Evidências/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Havaí , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto JovemRESUMO
This study examines factors associated with administration of a treatment monitoring assessment measure (the Ohio Scales) in the context of a precursor to a measurement feedback system in a youth public mental health setting. 82% of all state case managers (N = 46) completed interviews and administered at least one Ohio Scale over a 12-month period. A multi-level model accounting for variance between both case managers and their administrative offices indicated that case manager characteristics (lower self-reported burnout, more experience) and monthly caseload characteristics (fewer active cases, younger average age of youth, and increased time since initial administration) predicted increased monthly administration proportions.
Assuntos
Gerentes de Casos/psicologia , Retroalimentação , Serviços de Saúde Mental/organização & administração , Avaliação de Programas e Projetos de Saúde/métodos , Carga de Trabalho/estatística & dados numéricos , Sucesso Acadêmico , Adolescente , Adulto , Fatores Etários , Idoso , Atitude do Pessoal de Saúde , Esgotamento Profissional/epidemiologia , Feminino , Humanos , Masculino , Transtornos Mentais/terapia , Serviços de Saúde Mental/normas , Pessoa de Meia-Idade , Fatores Socioeconômicos , Fatores de TempoRESUMO
The current investigation conducted descriptive analyses on key variables in community-based residential (CBR) settings and investigated the extent to which disruptive youth between the ages of 13 and 17 years improved based on therapists' reported alignment with using practices derived from the evidence-base (PDEBs). Results from both the descriptive analyses and multilevel modeling suggested that therapists are using practices that both do and do not align with the evidence-base for disruptive youth. In addition, both PDEBs and practices with minimal evidence-support predicted or marginally predicted final average progress rating for these youth. Findings are discussed as they relate to the importance of continued exploration of treatment outcomes for CBR youth.
Assuntos
Serviços Comunitários de Saúde Mental , Prática Clínica Baseada em Evidências , Avaliação de Resultados em Cuidados de Saúde , Comportamento Problema/psicologia , Adolescente , Feminino , Previsões , Humanos , MasculinoRESUMO
Increasing evidence-based practice (EBP) use in community mental health is a national priority, especially given that one in five youth will suffer from mental health concerns before adulthood. Implementation science offers a unique lens for understanding EBP use that identifies barriers and facilitators of successful adoption. Consumer engagement is often overlooked as an EBP implementation strategy. In this article, we describe the State of Hawai'i Child and Adolescent Mental Health Division's innovative effort to target consumer EBP demand via the Help Your Keiki Website. Feedback from community stakeholders and website analytics converge to suggest that the most helpful content is related to finding help, normalizing concerns, and questions to ask therapists. Future outreach efforts as well as ongoing improvement and enhancement of the website are discussed.
Assuntos
Cuidadores/psicologia , Serviços de Saúde Mental/tendências , Adolescente , Serviços de Saúde do Adolescente/tendências , Adulto , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/tendências , Feminino , Havaí , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Saúde Pública/métodos , Saúde Pública/tendênciasRESUMO
Examining therapist evidence-based practice (EBP) knowledge seems an important step for supporting successful implementation. Advances in implementation science suggest a distinction between practice specific (i.e., knowing which practices are derived from the evidence base) and EBP process (i.e., integrating research evidence, clinical experience, client characteristics, and monitoring outcomes) knowledge. An examination of how these knowledge types are measured and relate to attitudes appears warranted. In our sample of 58 youth community therapists, both practice specific and EBP process knowledge accounted for EBP attitude scores, which varied by therapist demographic variables. Implications for measurement of therapist constructs and future research in identifying therapist predictors of EBP use and youth clinical improvement are discussed.
Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde Mental/organização & administração , Psicoterapia , Adolescente , Adulto , Idoso , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/normas , Feminino , Humanos , Masculino , Serviços de Saúde Mental/normas , Pessoa de Meia-Idade , Padrões de Prática Médica , Fatores SocioeconômicosRESUMO
To help facilitate the dissemination and implementation of evidence-based assessment practices, we examined the psychometric properties of the shortened 25-item version of the Revised Child Anxiety and Depression Scale-parent report (RCADS-25-P), which was based on the same items as the previously published shortened 25-item child version. We used two independent samples of youth-a school sample ( N = 967, Grades 3-12) and clinical sample ( N = 433; 6-18 years)-to examine the factor structure, reliability, and validity of the RCADS-25-P scale scores. Results revealed that the two-factor structure (i.e., depression and broad anxiety factor) fit the data well in both the school and clinical sample. All reliability estimates, including test-retest indices, exceeded benchmark for good reliability. In the school sample, the RCADS-25-P scale scores converged significantly with related criterion measures and diverged with nonrelated criterion measures. In the clinical sample, the RCADS-25-P scale scores successfully discriminated between those with and without target problem diagnoses. In both samples, child-parent agreement indices were in the expected ranges. Normative data were also reported. The RCADS-25-P thus demonstrated robust psychometric properties across both a school and clinical sample as an effective brief screening instrument to assess for depression and anxiety in children and adolescents.
Assuntos
Comportamento do Adolescente/psicologia , Ansiedade/diagnóstico , Transtornos do Comportamento Infantil/diagnóstico , Depressão/diagnóstico , Escalas de Graduação Psiquiátrica/normas , Adolescente , Adulto , Idoso , Análise de Variância , Cuidadores , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pais , Psicometria , Reprodutibilidade dos Testes , Instituições Acadêmicas , Adulto JovemRESUMO
Although significant progress has been made in the identification of youth evidence-based practices, the adoption of these interventions into community-based mental health care remains limited. Dissemination and implementation (DI) research has the potential to bridge this science-practice gap in clinical psychology. The theory of planned behavior (TPB) offers a useful conceptualization of individual behavior change including behavioral intention as defined by attitudes, subjective norms, and perceived behavioral control. To facilitate application of this model to DI efforts, the current study explores perspectives about using evidence-based practice from stakeholders in the field of youth mental health (including clinical supervisors, case managers, administrators at the departments of health and education, and direct service providers in clinic-based, school-based, and intensive in-home settings) within the TPB framework. A set of instrument items was created from this rich qualitative data using a rigorous mixed-method content validation approach. Instrument items are provided for future use in DI research.
Assuntos
Atitude do Pessoal de Saúde , Terapia Comportamental , Prática Clínica Baseada em Evidências , Pessoal de Saúde/psicologia , Psicologia do Adolescente/métodos , Psicologia da Criança/métodos , Adolescente , Comportamento do Adolescente/psicologia , Terapia Comportamental/métodos , Criança , Comportamento Infantil/psicologia , Serviços Comunitários de Saúde Mental , Aconselhamento , Havaí , Humanos , Entrevistas como Assunto , Teoria Psicológica , Psicologia Clínica/métodos , Instituições AcadêmicasRESUMO
Despite the accumulated research support for the use of evidence-based practices (EBPs) with youth, these treatment approaches remain underutilized in community settings. Therapist attitudes towards EBPs play a pivotal role in their adoption and implementation of these practices. The present investigation employs joint exploratory factor analysis to evaluate the structure of two measures of therapist attitudes, the Evidence-Based Practices Attitudes Scale and the Modified Practice Attitude Scale. Results suggest three factors including (a) importance of clinical experience over EBPs, (b) clinician openness to change, and (c) problems with EBPs. Recommendations are provided for future evaluation of therapist attitudes and associated characteristics.
Assuntos
Atitude do Pessoal de Saúde , Prática Clínica Baseada em Evidências , Serviços de Saúde Mental , Psicoterapia , Adulto , Idoso , Análise Fatorial , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
This study examines implementation facilitators and barriers of a statewide roll-out of a measurement feedback system (MFS) in a youth public mental health system. 76 % of all state care coordinators (N = 47) completed interviews, which were coded via content analysis until saturation. Facilitators (e.g., recognition of the MFS's clinical utility) and barriers (e.g., MFS's reliability and validity) emerged paralleling the Exploration, Adoption/Preparation, Implementation, and Sustainment framework outlined by Aarons et al. (Adm Policy Mental Health Mental Health Serv Res, 38:4-23, 2011). Sustainment efforts may leverage innovation fit, individual adopter, and system related facilitators.
Assuntos
Serviços de Saúde do Adolescente/normas , Serviços de Saúde da Criança/normas , Retroalimentação , Serviços de Saúde Mental/normas , Garantia da Qualidade dos Cuidados de Saúde , Adolescente , Adulto , Idoso , Atitude do Pessoal de Saúde , Criança , Havaí , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: To examine self-reported positive affect (PA) and negative affect (NA) among youth with ADHD (only and comorbid) and other non-ADHD-referred youth in an ethnically diverse clinical sample. METHOD: Semi-structured interviews identified 80 pure ADHD, 284 ADHD plus one or more comorbidities, and 730 non-ADHD youth (e.g., other diagnoses or no diagnosis). The Positive and Negative Affect Scale-Children (PANAS-C) was used to assess affective states. RESULTS: Even after controlling for the influence of potential confounds, youth with only ADHD reported higher PA and lower NA than other clinic-referred youth. The ADHD-comorbid group reported higher PA than the "non-ADHD" group, but these groups did not differ on level of NA. ADHD subtype did not influence results. CONCLUSION: Among clinic-referred youth, ADHD is associated with higher levels of PA and when there are no comorbid disorders, lower levels of NA.
Assuntos
Afeto , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Adolescente , Ansiedade/epidemiologia , Ansiedade/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Criança , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Escalas de Graduação Psiquiátrica , Testes PsicológicosRESUMO
Recent developments for disseminating and implementing evidence-based practices (EBPs) have emphasized the importance of increasing therapists' knowledge of such techniques. However, systematic efforts to measure knowledge in therapists serving youth have mostly relied on poorly researched study-specific measures. This study investigated the structure of EBP knowledge in a large sample of youth community therapists (N = 240) via a therapist report instrument emphasizing therapeutic commonalities across various types of treatment approaches. Findings supported a three-factor structure of knowledge with scores on factors varying by therapists' primary practice setting and education level. The relationships between therapist knowledge of and attitudes towards EBPs are also discussed.
Assuntos
Competência Clínica , Serviços Comunitários de Saúde Mental , Prática Clínica Baseada em Evidências , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Adulto , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto JovemRESUMO
This project investigated the extent to which knowledge of evidence-based practices (EBPs) and organizational characteristics predicted attitudes toward EBPs, while controlling for social desirability and organization membership. Participants were 167 public sector youth practitioners. Hierarchical multiple regression analyses were conducted to determine which factors significantly predicted EBP attitudes. Findings suggested that social desirability, organization membership, and various organizational characteristics predicted EBP attitudes. Results are discussed as they relate to the importance of including social desirability in future research and identifying different factors that influence EBP attitudes across various organizations.
Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Escolar/organização & administração , Desejabilidade Social , Adolescente , Prática Clínica Baseada em Evidências , Feminino , Humanos , MasculinoRESUMO
OBJECTIVE: To investigate the association between protocol design and therapist satisfaction in the Child STEPs Randomized Effectiveness Trial (Weisz et al., 2012). METHOD: Therapist report was obtained at the close of 145 cases seen by 77 therapists, each of whom was randomized to a Standard evidence-based treatment (EBT), modular EBT, or usual care (UC) condition. RESULTS: Analysis of satisfaction items revealed 2 correlated factors representing perceived effectiveness and perceived responsiveness of the treatments. Therapist total satisfaction scores were significantly higher for cases in the modular condition than for those in the standard EBT or UC conditions. With regard to specific dimensions, the modular and UC cases were rated significantly higher than standard EBT cases on the Responsiveness scale, whereas modular and standard EBT cases were rated significantly higher than UC on the Effectiveness scale. Finally, increases in Effectiveness scores from first to second case were significantly larger for Modular cases than for cases in both other study conditions, and increases from first to second case in Total Satisfaction scores were significantly larger for modular cases than for UC cases. CONCLUSIONS: Therapist satisfaction with a treatment approach has independent dimensions, which can vary as a function of the protocol design. By virtue of being perceived as more effective than UC and more responsive than standard EBTs, the modular protocol design was also viewed as more overall satisfying than both, and secondary analysis suggested that these results were not due to mere first impressions of the protocols.
Assuntos
Protocolos Clínicos , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Satisfação Pessoal , Psicoterapia/métodos , Adulto , Criança , Pesquisa Comparativa da Efetividade , Medicina Baseada em Evidências , Análise Fatorial , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Psicoterapia/estatística & dados numéricos , Projetos de Pesquisa , Autorrelato , Resultado do TratamentoRESUMO
Practice data from 74 therapists providing public mental health services to 519 youth ages 5-19 were examined. Multilevel modeling suggested child and therapist characteristics predicted use of practices derived from the evidence-base (PDEB) and use of practices with minimal evidence support (PMES). Longer episode length predicted greater receipt of PDEB; older youth, males, and youth in out-of-home levels of care were more likely to receive PMES; and youth receiving an evidence-based treatment program were less likely to receive PMES. Professional specialty and theoretical orientation significantly predicted PDEB whereas therapist characteristics did not predict PMES. Implementation implications are discussed.
Assuntos
Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Prática Clínica Baseada em Evidências/estatística & dados numéricos , Transtornos Mentais/terapia , Psicoterapia/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Aconselhamento , Terapia Familiar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multinível , Avaliação de Processos em Cuidados de Saúde , Psiquiatria , Teoria Psicológica , Psicologia , Fatores Sexuais , Serviço Social , Fatores de Tempo , Adulto JovemRESUMO
The purpose of this small pilot study was three-fold: (a) to begin development of a coding scheme for supervisor and therapist skill acquisition, (b) to preliminarily investigate a pilot train-the-trainer paradigm for skill development, and (c) to evaluate self-reported versus observed indicators of skill mastery in that pilot program. Participants included four supervisor-therapist dyads (N = 8) working with public mental health sector youth. Master trainers taught cognitive-behavioral therapy techniques to supervisors, who in turn trained therapists on these techniques. Supervisor and therapist skill acquisition and supervisor use of teaching strategies were repeatedly assessed through coding of scripted role-plays with a multiple-baseline across participants and behaviors design. The coding system, the Practice Element Train the Trainer - Supervisor/Therapist Versions of the Therapy Process Observational Coding System for Child Psychotherapy, was developed and evaluated though the course of the investigation. The coding scheme demonstrated excellent reliability (ICCs [1,2] = 0.81-0.91) across 168 video recordings. As calculated through within-subject effect sizes, supervisor and therapist participants, respectively, evidenced skill improvements related to teaching and performing therapy techniques. Self-reported indicators of skill mastery were inflated in comparison to observed skill mastery. Findings lend initial support for further developing an evaluative approach for a train-the-trainer effort focused on disseminating evidence-based practices.
Assuntos
Competência Clínica , Terapia Cognitivo-Comportamental/educação , Educação Médica Continuada/métodos , Pessoal de Saúde/educação , Adolescente , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Projetos PilotoRESUMO
Little is known about the types of psychotherapeutic practices delivered to youth with comorbid and multimorbid diagnoses in community settings. The present study, based on therapists' self-reported practices with 569 youth diagnosed with a disruptive behavior disorder (ODD or CD), examined whether specific therapeutic practice applications varied as a function of the number and type of comorbid disorders. While type of comorbid disorder (AD/HD or internalizing) did not predict therapists' practices, youth with more than two diagnoses (multimorbid) received treatment characterized by a more diverse set and a higher dosage of practices.