The Peabody Treatment Progress Battery: history and methods for developing a comprehensive measurement battery for youth mental health.

There is increased need for comprehensive, flexible, and evidence-based approaches to measuring the process and outcomes of youth mental health treatment. This paper introduces a special issue dedicated to the Peabody Treatment Progress Battery (PTPB), a battery of measures created to meet this need. The PTPB is an integrated set of brief, reliable, and valid instruments that can be administered efficiently at low cost and can provide systematic feedback for use in treatment planning. It includes eleven measures completed by youth, caregivers, and/or clinicians that assess clinically-relevant constructs such as symptom severity, therapeutic alliance, life satisfaction, motivation for treatment, hope, treatment expectations, caregiver strain, and service satisfaction. This introductory article describes the rationale for the PTPB and its development and evaluation, detailing the specific analytic approaches utilized by the different papers in the special issue and a description of the study and samples from which the participants were taken.

Brief Multidimensional Students' Life Satisfaction Scale-PTPB Version (BMSLSS-PTPB): psychometric properties and relationship with mental health symptom severity over time.

Youth life satisfaction is a component of subjective well-being, an important part of a strengths-based approach to treatment. This study establishes the psychometric properties of the Brief Multidimensional Students' Life Satisfaction Scale-PTPB Version (BMSLSS-PTPB). The BMSLSS-PTPB showed evidence of construct validity with significant correlations as expected to measures of youth hope and youth symptom severity, and no relationship as expected to youth treatment outcome expectations. A longitudinal analysis was conducted examining the relationship between youth-reported life satisfaction and mental health symptom severity (youth-, caregiver-, and clinician-report) for 334 youth (aged 11-18 years) receiving in-home treatment. Results indicated that life satisfaction consistently increased over the course of treatment but increased faster in youth whose symptom severity, as rated by all reporters, decreased over the course of treatment. Implications, future directions, and limitations of the study are discussed.

Validation and use of the Children's Hope Scale-revised PTPB edition (CHS-PTPB): high initial youth hope and elevated baseline symptomatology predict poor treatment outcomes.

The present study examined the relationship between initial youth hope, measured within the first 4 weeks of mental health treatment, and treatment progress over time (self-, caregiver-, and clinician-report of symptom severity) in a clinical sample of youth ages 11-18 years (N = 356). The psychometric properties of the CHS-PTPB, a revised version of the Children's Hope Scale, are also presented. Results indicate the CHS-PTPB is a psychometrically sound measure for use in this population. Additionally, results found that while higher levels of hope were associated with lower levels of symptom severity at baseline, initial level of hope was not significantly related to symptom improvement over time as reported by the youth and caregiver. Surprisingly, higher initial hope predicted slower treatment progress as rated by clinicians. According to clinician-rated symptom severity, youth with high initial hope and high baseline symptom severity show the poorest predicted clinical outcome. Implications, future directions, and limitations of the study are discussed.

The Session Report Form (SRF): are clinicians addressing concerns reported by youth and caregivers?

This study explores the relationship between clinician-reported content addressed in sessions, measured with the Session Report Form (SRF), and multi-informant problem alerts stemming from a larger battery of treatment process and progress measures. Multilevel Multinomial Logit Models were conducted with 133 clinicians and 299 youths receiving home-based treatment (N = 3,143 sessions). Results indicate a strong relationship between session content and problems related to youth symptoms and functioning as reported by clinicians in the same session. Session content was related to emotional, family, and friend/peer problems reported by youth and youth behavioral problems reported by caregivers. High-risk problems (alcohol/substance use, harm to self or others) were strongly related to session content regardless of informant. Session content was not related to problem alerts associated with the treatment process, caregiver strain, or client/caregiver strengths. The SRF appears to be a useful measure for assessing common themes addressed in routine mental health settings.

The Technology of Measurement Feedback Systems.

Usual care in the community is far from optimal. Sufficient evidence exists that dropout rates are significant, treatment is effective for only a small proportion of clients, and that the translation of evidence-based treatments to the real world is problematic. Technology has been shown to be helpful in health care in improving the effectiveness of treatment. A relatively new technology being used in mental health is measurement feedback systems (MFSs). MFSs are particularly applicable to couple and family psychology (CFP) because of its ability to provide information on the multiple perspectives involved in treatment. The Contextualized Feedback Systemstm (CFS®), developed at Vanderbilt University is used as an example of what can be accomplished with an MFS. The advantages and limitations of this technology are described as well as the anticipated reimbursement requirements that mental health services will need.

Developing effective research-practice partnerships for creating a culture of evidence-based decision making.

With growing evidence that treatment as usual may have limited effectiveness in mental health the pressure on service providers to be accountable and produce evidence as to the effectiveness of their services has increased. Measurement Feedback Systems, such as the Contextualized Feedback System (CFS), have the potential to be powerful tools for service providers in assessing their own effectiveness at multiple levels with an organization. These systems represent an amalgamation of the data driven world of science and the experience driven world of clinical practice. However, the synthesis of these two worlds is not without significant challenges as these two very different cultures can easily clash. The key for successful collaboration in developing and implementing Measurement Feedback Systems is a good university-practice partnership that has a strong foundation in common goals and the positive relationships among its members. In addition, the partnership needs to be flexible so that it can adapt to new challenges and continuously grow with each obstacle. These are some of several lessons learned the authors of this article will share as part of their experience with developing and implementing CFS in one of the largest behavioral health service providers in the U.S.

Effects of routine feedback to clinicians on mental health outcomes of youths: results of a randomized trial.

OBJECTIVE: A randomized cluster controlled trial tested the hypothesis that weekly feedback to clinicians would improve the effectiveness of home-based mental health treatment received by youths in community settings. METHODS: Youths, caregivers, and clinicians at 28 sites in ten states completed assessments of the youths' symptoms and functioning every other week. Clinicians at 13 sites were provided with weekly feedback about the assessments, and clinicians at 15 sites received feedback every 90 days. Data were collected from June 1, 2006, through December 31, 2008. Intent-to-treat analyses were conducted with hierarchical linear modeling of data provided by youths, caregivers, and clinicians. RESULTS: Assessments by youths, caregivers, and clinicians indicated that youths (N=173) treated at sites where clinicians could receive weekly feedback improved faster than youths (N=167) treated at sites where clinicians did not receive weekly feedback. A dose-response analysis showed even stronger effects when clinicians viewed more feedback reports. CONCLUSIONS: Routine measurement and feedback can be used to improve outcomes for youths who receive typical home-based services in the community.

Family functioning and posttraumatic stress symptoms in youth and their parents after unintentional pediatric injury.

This study examined the association between family functioning and the development of posttraumatic stress symptoms (PTSS) in youth and parents following an unintentional traumatic injury of a child. Fifty-one parent-child dyads completed questionnaires and a structured interview assessing PTSS and family functioning. Multiple regression analyses were applied to evaluate the contribution of family functioning to the development of PTSS after controlling for demographic characteristics and known predictors. Family functioning had both direct and moderating influences on the development of PTSS in parents. We were unable to demonstrate a systematic impact of family functioning on the development of PTSS in children from the same families.

Exploring the black box: measuring youth treatment process and progress in usual care.

The session report form (SRF) is a 25-item self-report measure scheduled to be completed by clinicians at the end of each session. This study addresses the utility of the SRF for describing session content by exploring patterns of self-reported behavior of 235 clinicians in 7,058 sessions with 600 clients. Results indicate that the SRF has a distinct subscale of treatment process and provides an adequate range of topics related to session content while also discriminating between client and clinician influences on patterns of topics addressed. The SRF is a promising measure meeting a significant need in describing session content in usual care.

Finding the common core: evidence-based practices, clinically relevant evidence, and core mechanisms of change.

Improving the quality of children's mental health care can benefit from the adoption of evidence based and evidence informed treatments. However, the promise of moving science into practice is hampered by three core elements that need to be addressed in the current conversation among key stakeholders: (1) expanding our understanding of the clinical relevance of different types of evidence, (2) emphasizing the identification of core mechanisms of change, and (3) re-conceptualizing what evidence-based practice means. This paper focuses on these elements in an attempt to find a common core among stakeholders that may create opportunities for more inclusive conversation to move the field of children's mental health care forward.

Beyond outcomes monitoring: measurement feedback systems in child and adolescent clinical practice.

PURPOSE OF REVIEW: To review the literature published during the past year relevant to identifying the best measures for monitoring progress in the treatment of child and adolescent clients and their families. RECENT FINDINGS: The current literature shows an increasing focus on clinical utility in measure development as demonstrated by the recent emphasis on evidence-based assessment. However, there is very little research on how the inclusion of monitoring might enhance clinician practice and ultimately youth and family outcomes. There is great promise in expanding our thinking beyond mere outcome measurement to a measurement feedback system that provides timely feedback that is comprehensive and concurrent with treatment. SUMMARY: Investment in the development of measurement feedback systems is needed to enhance clinical judgment and increase effectiveness of treatment. Clinical utility and consumer appeal need to be key considerations for measures intended to be used in everyday clinical practice. Most importantly, we must harness the power of technology and advances in measurement to provide clinicians with the tools to use effectively the systematic data provided through frequent measurement with measurement feedback systems.

Integrating medical and psychological health care for children with atopic dermatitis.

OBJECTIVE: To present descriptive data from a hospital-based interdisciplinary program that provides integrated medical and psychological health-care for children with atopic dermatitis (AD). METHODS: Clinical records were reviewed for 69 children seen in our program to examine parent-reported AD-related presenting concerns, as well as common problems and interventions addressed during family visits with the program psychologist. RESULTS: The most common presenting concerns included child itching and scratching and associated sleep problems. Parent initial request for a meeting with the program psychologist was not related to child disease severity, but was associated with child sleep problems and parent emotional and practical challenges in managing the child's condition. CONCLUSIONS: Results support the need for, acceptance of, and feasibility of providing integrated care for children with AD and their families. Changes to our clinical model based on study findings are discussed.