Improving measurement feedback systems for measurement-based care.

AbstractObjectives: Measurement feedback systems (MFS) are a class of health information technologies developed to facilitate measurement-based care. The individual clinical decision support features within MFS are diverse and their influence on clinicians is largely unknown. This study tested the impact of MFS features on clinicians' progress assessments and treatment decisions in different scenarios. Method: Clinicians (n = 299) were randomly assigned to view one of six combinations of the following MFS features: graph, expected change trajectory line, alert, and treatment suggestions. The assigned feature combination was paired with three vignettes and clinical data representing three clinical scenarios: patient deterioration, no progress, and approaching remission. Clinicians answered questions after each vignette, and at the conclusion. Results: MFS features differentially impacted clinicians' progress assessment accuracy, their likelihood of making a treatment change, and their treatment choices. Which feature was most impactful varied depending on the clinical scenario. Clinicians reported graphs influenced their assessments and choices significantly more than the other features, and the majority stated they would prefer to use all of the features. Conclusions: Specific MFS features impact clinicians' assessments and choices to greater degrees, and the impact of those features can be influenced by the clinical state of the patient.

Leveraging Health Information Technology to Meet The Joint Commission's Standard for Measurement-Based Care: A Case Study.

INTRODUCTION: Three decades of research have shown that routinely collecting patient-reported outcomes throughout treatment to inform clinical decision making or measurement-based care (MBC) can improve clinical outcomes, yet widespread adoption continues to be elusive. APPROACH: This article describes how a community behavioral health center addressed Element of Performance (EP) 1 of The Joint Commission's revised MBC standard using health information technology (HIT)-facilitated MBC and a comprehensive implementation plan grounded in the Consolidated Framework for Implementation Research. RESULTS: Across the initial 15-month implementation period, 96.8% of patients who had an intake evaluation also completed baseline measurements via an HIT known as a measurement feedback system (MFS), and 91.5% (78.6%-100%) completed at least one repeated measure. CONCLUSION: MFS reduces many of the logistical barriers of MBC, but implementation of MFS-facilitated MBC requires a comprehensive implementation plan that includes strategies to address barriers across all relevant domains for successful uptake.

Evaluation of the Brief Adjustment Scale-6 (BASE-6): A measure of general psychological adjustment for measurement-based care.

The current study evaluated the Brief Adjustment Scale-6 (BASE-6), a measure of general psychological adjustment. The psychometric properties of the BASE-6 are documented using 3 adult samples, including online participants (Sample 1: n = 459), college students (Sample 2: n = 244), and a clinical sample (Sample 3: n = 296). Acceptability ratings comparing the BASE-6 to the Outcome Questionnaire-45.2 (OQ-45.2; Lambert et al., 1996) are provided. Factor analyses showed the items were well represented by a single factor, indicating a unidimensional factor structure. The BASE-6 demonstrated good internal consistency (α = .87-.93) and there was good test-retest reliability (intraclass correlation = .77) across 1 week. In Samples 1 and 2, there was moderate to high convergent validity with the OQ-45.2 total score (r = .66-.81, p < .001), and Symptom Distress (r = .66-.80, p < .001), Interpersonal (r = .54-.68, p < .001), and Social Role (r = .57-.69, p < .001) subscales. In Sample 3, there was high convergent validity with the Patient Health Questionnaire-9 (r = .80, p < .001) and the Generalized Anxiety Disorder-7 (r = .76, p < .001). BASE-6 item and total scores were generally higher in the clinical sample compared with the nonclinical samples. Participants perceived the BASE-6 as easier to use, and more acceptable on a weekly basis compared with the OQ-45.2. Results provide preliminary evidence that the BASE-6 has acceptable psychometric properties and may show promise in the context of measurement-based care. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Beginning to envision a life worth living: An introduction to pretreatment sessions in dialectical behavior therapy.

The pretreatment phase in dialectical behavior therapy (DBT) sets the critical foundation for working with multiproblem, often highly suicidal clients. Despite the importance of this stage of treatment, very little has been written to aid DBT clinicians in navigating these early sessions most effectively. This article describes the functions and goals of pretreatment in DBT and research relevant to strategies employed in pretreatment. Additionally, a case example of a pretreatment session in DBT is provided, and challenges commonly encountered in pretreatment are discussed, along with recommendations for overcoming those challenges. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Enhancing Stress Management Coping Skills Using Induced Affect and Collaborative Daily Assessment.

The purpose of this paper is to highlight the use of induced affect (IA) and collaborative (therapeutic) assessment (CA) as components of Cognitive-Affective Stress Management Training (CASMT). IA is a technique for rehearsing cognitive and physical relaxationcoping skills under conditions of high affective arousal, which has been shown to result in high levels of coping self-efficacy. CA provides diary-based feedback to clients about the processes underlying theirstress experiences and helps identify affect-arousing experiences to be targeted by IA. We include descriptions of the IA technique and anonline stress and coping daily diary, as well as sample transcripts illustrating how CA is integrated into CASMT and how IA evokes high affective arousal and skills rehearsal. To illustrate idiographic assessment, we also describe threetreatment cases involving female clients between the ages of 20 and 35 with anxiety symptoms who participated in six weeks of CASMT and reported their daily stress and coping experiences (before, during, and following the intervention)for a total of ten weeks. The resulting time series data, analyzed using Simulation Modeling Analysis (SMA), revealed that all clients reported improved negative affect regulation over the course of treatment, yet they exhibited idiographic patterns of change on other outcome and coping skills variables. These results illustrate how IA and CA may be used to enhance emotional self-regulation and how time-series analyses can identify idiographic aspects of treatment response that would not be evident in group data.

Pilot randomized controlled trial of dialectical behavior therapy group skills training for ADHD among college students.

OBJECTIVE: ADHD affects between 2% and 8% of college students and is associated with broad functional impairment. No prior randomized controlled trials with this population have been published. The present study is a pilot randomized controlled trial evaluating dialectical behavior therapy (DBT) group skills training adapted for college students with ADHD. METHOD: Thirty-three undergraduates with ADHD between ages 18 and 24 were randomized to receive either DBT group skills training or skills handouts during an 8-week intervention phase. ADHD symptoms, executive functioning (EF), and related outcomes were assessed at baseline, post-treatment, and 3-month follow-up. RESULTS: Participants receiving DBT group skills training showed greater treatment response rates (59-65% vs. 19-25%) and clinical recovery rates (53-59% vs. 6-13%) on ADHD symptoms and EF, and greater improvements in quality of life. CONCLUSION: DBT group skills training may be efficacious, acceptable, and feasible for treating ADHD among college students. A larger randomized trial is needed for further evaluation.