Behavioral health engagement and treatment strategies: Pediatric chief resident perspectives.

INTRODUCTION: Despite increasing evidence that use of the "common factors" and "common elements" approaches are effective in improving patient outcomes, and calls for pediatricians to address patient behavioral health concerns, little is known about pediatrician knowledge, perceptions, and use of these approaches. METHOD: Pediatric chief residents from all 210 pediatric residency programs in the United States were surveyed to investigate their knowledge, attitudes, practices, and training related to use of engagement and treatment strategies that comprise the common factors and common elements approaches to delivering behavioral health care. RESULTS: The usable response rate was 38%. Most respondents indicated they believe pediatricians should address behavioral health issues and that common factors and common elements would be useful and feasible in clinical practice. Most indicated low levels of familiarity with common factors and common elements and dissatisfaction with training in these areas. CONCLUSION: Additional training and other implementation supports, such as dissemination of implementation guidelines and mechanisms for technical assistance, will be needed in order to increase pediatrician use of these approaches. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychotropic Medication Prescribing in Primary Care: Pediatric Chief Resident Perspectives.

OBJECTIVE: Evidence-based treatments for mental health concerns include psychopharmacological and psychosocial approaches. Pediatrics organizations indicate psychopharmacology needs to be a component of training. This study investigated the status of training in psychotropic medication prescribing through a national survey of pediatric chief residents. METHOD: Pediatric chief residents (one per residency program) completed a survey (response rate = 60.2%, 127/211) about their attitudes, knowledge, comfort, practice, and training around prescribing psychotropic medication in primary care. Quantitative data included descriptive statistics and correlational analyses to explore relationships between variables; qualitative data were examined through classical content analysis. RESULTS: Almost half of respondents reported prescribing sometimes or often. Frequency of prescribing varied by mental health condition, with highest frequency for attention-deficit/hyperactivity disorder. About two-thirds of respondents reported having at least some/average knowledge. About half of respondents reported being uncomfortable with prescribing; respondents were most uncomfortable with prescribing antianxiety, mood stabilizing, and antipsychotic medications, and with discontinuing medication; about half indicated their competence in progress-monitoring needed improvement. Concurrent psychosocial treatment was perceived as very useful, although often inaccessible to patients. Prescribing frequency was related to knowledge, comfort, progress-monitoring competence, and training quality; training quality was related to knowledge and comfort. Over 60% rated their training as not at all or only somewhat adequate. CONCLUSIONS: Pediatric chief residents reported having knowledge of psychotropic medication issues, but experience a general discomfort, especially with discontinuing medication, and with medications other than stimulants. Most thought their training needed improvement in terms of comprehensiveness and clinical practice experiences.

Assessment and management of depression and suicidality: Pediatric resident perspectives on training and practice.

INTRODUCTION: Primary care is a common access point for children and adolescents with depression and suicidality concerns. In this setting, pediatricians typically function as front-line providers given barriers that patients face in accessing mental health clinicians. METHOD: This study surveyed chief residents from all pediatric residency programs in the United States (N = 214) to evaluate (a) their attitudes, knowledge, practices, and comfort in managing depression and suicidality concerns in primary care, and (b) the relationship between residency training processes and pediatric residents' practices, knowledge, and comfort related to identifying and managing depression and suicidality. RESULTS: The usable response rate was 37.6%. The large majority of respondents are involved in evaluation and management of depression and suicidality; yet many respondents reported a lack of knowledge and comfort in these roles. CONCLUSIONS: Recommendations for pediatric residency program training processes are discussed, including the potential added value of colocating mental health clinicians into the primary care continuity training clinic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The magnitude and precision of estimates of change in formative teacher assessment.

Despite growing interest in formative assessment of teacher practices, research on rates of change in teachers' practices is sparse. This is the first study to examine the characteristics of observed change in classroom practices using the Classroom Strategies Assessment System (CSAS) across alternative schedules of data collection during instructional coaching. Our primary objectives included examining (a) the magnitude, variability, and precision of estimates of average rates of change in teacher practices and (b) the impact of data collection duration (i.e., number of weeks of data collection) and density (i.e., the number of classroom observations per week) on the precision of estimates of rates of change over time. A sample of teachers (N = 63) participating in instructional coaching was observed 14 times during coaching using the CSAS. Findings revealed a significant gradual improvement in strategy use, with significant between-teacher variation in rates of change. The frequency of observations was associated with the precision of estimates for average rates of change across teachers and for individual teachers, providing initial guidance on minimum number of observations required to monitor change in practice over time. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Measuring teacher practices and student academic engagement: A convergent validity study.

We examined the convergent validity of observer ratings of teachers' use of evidence-based instructional and behavior management practices using the Classroom Strategies Assessment System (CSAS; Reddy & Dudek, 2014) with student academic engagement as measured by the Cooperative Learning Observational Code for Kids (CLOCK; Volpe & DiPerna, 2010). This study was conducted with a sample of 107 teachers and 2,000 students in 11 urban elementary schools serving students in a community with high concentrations of poverty. Correlational and multiple linear regression analyses examined whether CSAS instructional and behavior management scores predicted classwide academic engagement. Results provide initial evidence of the relationship between observer ratings of teacher practices and student engagement. Specifically, CSAS scores indicating higher quality instruction and behavior management were associated with higher student engagement. Multiple linear regression revealed that instructional practice scores (as measured by the CSAS) uniquely predicted student academic engagement (i.e., attention and participation during instruction) while behavior management practice scores did not. Implications for future research and practice are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Assessment of teaching to predict gains in student achievement in urban schools.

We examined the degree to which assessment of teachers' instructional and behavior management practices, as measured by the Classroom Strategies Assessment System (CSAS; Reddy & Dudek, 2014), relates to gains in student achievement as measured by the Measures of Academic Progress (Northwest Evaluation Association [NWEA], 2011). Two-level hierarchical linear modeling was applied to achievement scores from 2,771 students in 130 kindergarten through 8th-grade classrooms in 13 urban schools serving students in communities with high concentrations of poverty. Results suggest that teachers' use of evidence-based instructional and behavior management strategies, as measured by the CSAS, were associated with reading and mathematics gains. In general, students in classrooms with higher quality use of evidence-based teaching strategies exhibited greater gains, whereas students in classrooms with lower quality use of effective strategies exhibited lesser gains. Implications of these findings for research and educational practice are presented. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Observer and student ratings of the class environment: A preliminary investigation of convergence.

The present study examined the relationship between student and observer ratings of the class environment. More specifically, class responses on the Responsive Environmental Assessment for Classroom Teaching (REACT; Theodore J. Christ & Colleagues, 2015) were compared with observer ratings on the Classroom Strategies Assessment System-Observer Form (Reddy, Fabiano, & Dudek, 2013). This study included 38 teachers and 582 students from 5 high-poverty schools. Observational data were reported as discrepancy scores, which reflect the difference between the recommended frequency and observed frequency of specific instructional and behavioral management strategies for classroom teachers. Pearson correlations were used to evaluate the relationship between the 6 subscales included on the REACT and the 9 subscales included on the CSAS-O. Results provide preliminary evidence for the relationship between observer and student ratings of the class environment. More specifically, as discrepancy scores decreased, student ratings of the class environment tended to be more positive. The relationship between the REACT and the CSAS-O differed across subscales; however, in general, subscales that were conceptually similar tended to demonstrate stronger relationships than subscales that were conceptually distinct. Thus, the observed results also provide preliminary evidence that students are capable of discriminating between the quality of different components of the class environment. The potential use of both observer and student ratings of the class environment to provide teachers with a more robust and comprehensive reference for professional development purposes is discussed within the context of a tiered model of support. (PsycINFO Database Record