The Content of Usual Clinical Care for Youth with Primary Anxiety Problems.

The current study was designed to describe usual clinical care for youth with primary anxiety problems in community mental health centers. The observer-rated Therapy Process Observational Coding System for Child Psychotherapy - Revised Strategies scale (TPOCS-RS), designed to assess therapeutic techniques from five theory-based domains, was used to code sessions (N = 403) from the usual clinical care group of two randomized effectiveness trials: (a) Youth Anxiety Study (YAS) with 21 youth (M age = 10.44 years, SD = 1.91; 49.2% Latinx; 46.6%, 53.4% male) and 16 clinicians (77.5% female; 43.8% White), and (b) Child STEPS Multisite Trial with 17 youth (M age = 10.00 years, SD = 1.87; 58.8% male; 41.2% White) and 13 clinicians (M age = 40.00 years; SD = 9.18; 76.9% female; 61.5% White). The average number of TPOCS-RS items observed per treatment session was more than 10, and multiple techniques were used together in each session. All TPOCS-RS items were observed at least once throughout a clinical case, and most items reoccurred (i.e., observed in two or more sessions). The dosage of TPOCS-RS in all items was below 5 on a 7-point scale. In conclusion, clinicians in both usual care samples used a wide range of techniques from several theory-based domains at a low to medium dose. However, the type and dosage of the techniques used did vary across the two samples.

Using Adherence and Competence Measures Based on Practice Elements to Evaluate Treatment Fidelity for Two CBT Programs for Youth Anxiety.

Measures designed to assess the quantity and quality of practices found across treatment programs for specific youth emotional or behavioral problems may be a good fit for evaluating treatment fidelity in effectiveness and implementation research. Treatment fidelity measures must demonstrate certain reliability and validity characteristics to realize this potential. This study examines the extent to which two observational measures, the Cognitive-Behavioral Treatment for Anxiety in Youth Adherence Scale (CBAY-A) and the CBAY Competence Scale (CBAY-C), can assess the quantity (the degree to which prescribed therapeutic techniques are delivered as intended) or quality (the competence with which prescribed techniques are delivered) of practices found in two distinct treatment programs for youth anxiety. Treatment sessions (N = 796) from 55 youth participants (M age = 9.89 years, SD = 1.71; 46% female; 55% White) with primary anxiety problems who participated in an effectiveness study were independently coded by raters who coded quantity, quality, and the youth-clinician alliance. Youth received one of three treatments: (a) standard (i.e., cognitive-behavioral therapy program), (b) modular (i.e., a cognitive-behavioral and parent-training program), and (c) usual clinical care. Interrater reliability for the CBAY-A items was good across the standard and modular conditions but mixed for the CBAY-C items. Across the standard and modular conditions, the CBAY-A Model subscale scores demonstrated evidence of construct validity, but the CBAY-C Model subscale scores showed mixed evidence. The results provide preliminary evidence that the CBAY-A can be used across different treatment programs but raise concerns about the generalizability of the CBAY-C.

Patient reported preferences for sleep interventions among women receiving buprenorphine for opioid use disorder.

Aim: Among individuals receiving medication for OUD (MOUD), insomnia is highly prevalent and increases the risk for negative OUD outcomes. However, little is known about MOUD patient-reported preferences for insomnia treatments among women with OUD. This mixed-methods study explored acceptability of and patient preferences for sleep interventions among women in OUD treatment. Methods: This is an analysis from an ongoing cross-sectional survey and interview study investigating the relationship between sleep and OUD recovery. The parent study is actively enrolling non-pregnant women between 18-45 years stabilized on buprenorphine from an outpatient program. Participants complete measures including the Insomnia Severity Index (ISI), with scores of ≥10 identifying clinically significant insomnia symptoms. A sub-sample who met this threshold completed semi-structured interviews. Descriptive statistics were generated for survey responses, and applied thematic analysis was used for interview data. Results: Participants selected for the qualitative interview (n = 11) highlighted prior positive and negative experiences with sleep treatments, challenges with employing non-pharmacological sleep strategies, and preferences for both medical and behavioral sleep interventions while in recovery. Women emphasized the need for flexibility of sleep therapy sessions to align with ongoing social determinants (e.g., caregiving responsibilities) as well as for sleep medications without sedating effects nor risk of dependency. Conclusions: Many women receiving MOUD have concomitant insomnia symptoms, and desire availability of both pharmacologic and behavioral sleep interventions within the OUD treatment setting. Qualitative findings underscore the need for evidence-based sleep interventions that account for the unique socioenvironmental factors that may impact strategy implementation in this population.

Psychiatric comorbidities and their treatment predict buprenorphine continuation among postpartum people with opioid use disorder.

Background: Opioid use disorder (OUD) is a growing crisis among pregnant and postpartum people. Psychiatric comorbidities are common, yet how they impact OUD treatment outcomes is not well characterized. The aim of this study was to assess the association of psychiatric comorbidities and receipt of psychiatric treatment with buprenorphine continuation through one year postpartum among a sample of people with OUD. Methods: A subsample was identified from a larger retrospective cohort of patients receiving buprenorphine for OUD at the time of delivery from an academic medical center between 2017 and 2020. Medical record abstractions were conducted during pregnancy through one year postpartum. Independent variables included any psychiatric diagnosis and postpartum receipt of psychiatric treatment (medication or behavioral health). The primary outcome was week of buprenorphine discontinuation. Cox Proportional Hazard models were used. Results: Of 138 patients, 71.8% had a psychiatric condition and 35.5% continued buprenorphine for a full year postpartum. Postpartum buprenorphine continuation was associated with (a) Psychiatric co-morbidity (buprenorphine discontinuation HR 0.49; 95% CI 0.29, 0.82), (b) Receipt of psychiatric medications in weeks 39-52 postpartum (buprenorphine discontinuation HR 0.21; 95% CI 0.06, 0.83), and (c) Receipt of behavioral health therapy in weeks 9-38 postpartum (buprenorphine discontinuation HR 0.40; 95% CI 0.18, 0.90). Conclusion: Our work suggests a dynamic relationship between OUD treatment outcomes, psychiatric comorbidities and receipt of psychiatric treatments through the highly vulnerable postpartum period. Clinicians and researchers alike should work to advance patient-centered engagement in integrated care models tailored for this unique population.

The Relationship between Health Disparities, Psychosocial Functioning and Health Outcomes in Pediatric Hematology-Oncology and Stem Cell Transplant Populations: Recommendations for Clinical Care.

Not only do racial and ethnic minority children and adolescents with chronic illness experience disparities in health status and health outcomes, they also experience significant healthcare disparities, including differences in healthcare coverage, access to care, and quality of care. It is well known that the interaction between psychosocial functioning, health behaviors and ethnic and racial disparities, ultimately leads to worse health and psychosocial outcomes in pediatric and AYA chronic illness patient populations, including increased rates of morbidity and mortality. Investigating the impact of racial and ethnic factors on health outcomes, and strategies for reducing these disparities, is of the utmost importance, specifically in life-threatening conditions like cancer and sickle cell disease. This commentary underscores the relative importance of identifying factors that could reduce disparities between minority and non-minority populations. This present paper will focus on the dynamic relationships between health disparities, psychosocial factors and health outcomes within pediatric cancer, sickle cell disease and bone marrow transplant populations, and will offer recommendations for healthcare professionals working with these vulnerable patient populations. The primary goal of this commentary is to provide recommendations for enhancing cultural competency and humility for those working with highly vulnerable patient populations.

Generalizability and Decision Studies of a Treatment Adherence Instrument.

Observational measurement of treatment adherence has long been considered the gold standard. However, little is known about either the generalizability of the scores from extant observational instruments or the sampling needed. We conducted generalizability (G) and decision (D) studies on two samples of recordings from two randomized controlled trials testing cognitive-behavioral therapy for youth anxiety in two different contexts: research versus community. Two doctoral students independently coded 543 session recordings from 52 patients treated by 13 therapists. The initial G-study demonstrated that context accounted for a disproportionately large share of variance, so we conducted G- and D-studies for the two contexts separately. Results suggested that reliable cognitive-behavioral therapy adherence studies require at least 10 sessions per patient, assuming 12 patients per therapists and two coders-a challenging threshold even in well-funded research. Implications, including the importance of evaluating alternatives to observational measurement, are discussed.

Agreement and Discrepancy Between Supervisor and Clinician Alliance: Associations with Clinicians' Perceptions of Psychological Climate and Emotional Exhaustion.

Despite increasing interest in supervision as a leverage point for bolstering public mental health services, the potential influence of supervisory alliance on organizations and direct service providers remains understudied, particularly in the context of supporting evidence-based treatment (EBT) use. This study examined agreement and discrepancy between supervisor and clinician ratings of alliance associated with clinicians' perceptions of psychological climate and emotional exhaustion. Results indicated that discrepancies in alliance ratings were common and associated with clinicians' perceptions of psychological climate. These findings have important implications for collaboration among supervisors and clinicians within a community mental health organizational context and the provision of EBTs.