A Structural Model of Organization and Clinician Factors Associated with Standardized Measure Use in a National Survey of Youth Mental Health Providers.

Standardized assessment measures are important for accurate diagnosis of mental health problems and for treatment planning and evaluation. However, little is known about youth mental health providers' typical use of standardized measures across disciplines and outside the context of evidence-based practice initiatives. A multidisciplinary national survey examined the frequency with which 674 youth mental health providers administer standardized and unstandardized measures, and the extent to which organizational (i.e., implementation climate, rigid hierarchical organizational structure) and provider (i.e., attitudes toward standardized assessment measures, highest degree, practice setting) characteristics are associated with standardized measure use. Providers used unstandardized measures far more frequently than standardized measures. Providers' perceptions (a) that standardized measures are practical or feasible, (b) that their organization supports and values evidence-based practices, and (c) that their organization has a rigid hierarchical structure predicted greater use of standardized measures. Working in schools predicted less frequent SMU, while working in higher education and other professional settings predicted more frequent SMU. Standardized measures were not routinely used in this community-based sample. A rigid hierarchical organizational structure may be conducive to more frequent administration of standardized measures, but it is unclear whether such providers actually utilize these measures for clinical decision-making. Alternative strategies to promote standardized measure use may include promoting organizational cultures that value empirical data and encouraging use of standardized measures and training providers to use pragmatic standardized measures for clinical decision making.

Secondary auditory cortex mediates a sensorimotor mechanism for action timing.

The ability to accurately determine when to perform an action is a fundamental brain function and vital to adaptive behavior. The behavioral mechanism and neural circuit for action timing, however, remain largely unknown. Using a new, self-paced action timing task in mice, we found that deprivation of auditory, but not somatosensory or visual input, disrupts learned action timing. The hearing effect was dependent on the auditory feedback derived from the animal's own actions, rather than passive environmental cues. Neuronal activity in the secondary auditory cortex was found to be both correlated with and necessary for the proper execution of learned action timing. Closed-loop, action-dependent optogenetic stimulation of the specific task-related neuronal population within the secondary auditory cortex rescued the key features of learned action timing under auditory deprivation. These results unveil a previously underappreciated sensorimotor mechanism in which the secondary auditory cortex transduces self-generated audiomotor feedback to control action timing.

Chiropractic Management of a Symptomatic Patient Who Previously Had Surgery for Cauda Equina Syndrome.

OBJECTIVE: The purpose of this report is to describe the outcomes of chiropractic care for a patient after surgery for cauda equina syndrome. CLINICAL FEATURES: Following surgery for cauda equina syndrome caused by a herniated lumbar disc at L5/S1, a 28-year old woman presented for chiropractic care with an 18-month history of lower back pain. She had bilateral L5 and S1 dermatome pain and paraesthesia; saddle anesthesia; bilateral leg weakness in the L4, L5, and S1 myotomes; and urinary incontinence. INTERVENTION AND OUTCOME: The patient received a variety of chiropractic manipulative techniques including cervical and thoracic spine manipulation, instrumented adjustments to the lumbar spine, and drop technique to the sacroiliac joints. Trigger point therapy was performed on the gluteus medius, quadratus lumborum, and piriformis muscles bilaterally. After 12 months, the patient reported a reduction in lower back and radicular leg pain, was able to reduce her use of opioid medications, and experienced improved lower limb function following chiropractic care. CONCLUSION: The patient responded favorably to a course of chiropractic care for symptoms remaining after surgery for cauda equina syndrome.

Do noncontingent incentives increase survey response rates among mental health providers? A randomized trial comparison.

Surveys can be a useful tool for mental health services research. Unfortunately, clinicians typically show low response rates to surveys. To determine whether noncontingent incentives would increase responses among clinicians, we compared no incentive versus four incentives (mood magnet, $1, $2, $5) on response to a 7-page self-report survey of mental health assessment and treatment practices in a sample of 500 clinicians from the 5 largest professional guilds. Noncontingent monetary incentives significantly increased response rate compared to no incentive across all disciplines. Noncontingent monetary incentives are discussed as a cost-effective method for increasing survey response rate among mental health clinicians.

Assessment Practices of Child Clinicians.

Assessment is an integral component of treatment. However, prior surveys indicate clinicians may not use standardized assessment strategies. We surveyed 1,510 clinicians and used multivariate analysis of variance to explore group differences in specific measure use. Clinicians used unstandardized measures more frequently than standardized measures, although psychologists used standardized measures more frequently than nonpsychologists. We also used latent profile analysis to classify clinicians based on their overall approach to assessment and examined associations between clinician-level variables and assessment class or profile membership. A four-profile model best fit the data. The largest profile consisted of clinicians who primarily used unstandardized assessments (76.7%), followed by broad-spectrum assessors who regularly use both standardized and unstandardized assessment (11.9%), and two smaller profiles of minimal (6.0%) and selective assessors (5.5%). Compared with broad-spectrum assessors, unstandardized and minimal assessors were less likely to report having adequate standardized measures training. Implications for clinical practice and training are discussed.