Study What You Do: Developing a Psychotherapy Tracking Database in a Large-Scale Integrated Behavioral Health Service.

PURPOSE: Many individuals with behavioral health challenges receive services in primary care, and integrated behavioral health (IBH) programs can help increase access to evidence-based interventions. IBH programs can benefit substantially from integrating standardized tracking databases that allow for the implementation of measurement-based care to evaluate patient-, clinician-, and practice-level outcomes. We describe the development and integration of Mayo Clinic's pediatric and adult primary care psychotherapy tracking database. METHODS: IBH practice leaders directed the development of a large psychotherapy tracking database that continuously populates from Mayo Clinic's electronic health record system. The database captures numerous patient variables including demographics, behavioral health and substance use issues, psychotherapy principles used, and self-reported symptoms. We retrieved current data for patients empaneled in Mayo Clinic's pediatric and adult primary care psychotherapy programs from June 2014 to June 2022. RESULTS: The tracking database contained data for 16,923 adult patients and 6,298 pediatric patients. The mean age of adult patients was 43.2 years (SD 18.3), 88.1% were non-Latine White, and 66.7% identified as female. The mean age of pediatric patients was 11.6 years (SD 4.2), 82.5% were non-Latine White, and 56.9% identified as female. We provide examples of practical applications of the database across clinical, educational, research, and administrative domains. CONCLUSIONS: The development and integration of a psychotherapy tracking database supports clinician communication, examination of patient outcomes, practice quality improvement efforts, and clinically relevant research. Our description of Mayo Clinic's IBH database may serve as a model for other IBH practices.

Subjective evaluations of alcohol-related consequences among college students: Experience with consequences matters.

OBJECTIVE: Research suggests college students rate some alcohol-related consequences less negatively than others, yet it is unclear how or when these differences in perception develop. The current study compared college students' subjective evaluations of alcohol-related consequences that they had and had not experienced in order to test the hypothesis that students become desensitized to the consequences they experience. PARTICIPANTS: Participants were 269 undergraduate students enrolled at a large, public, Midwestern university. METHODS: Participants completed measures of drinking behaviors, consequences experienced, and subjective evaluations of consequences via an online survey. RESULTS: Participants rated the consequences they had personally experienced more positively than those they had not experienced. Similarly, individuals who reported experiencing consequences rated them as significantly more positive than those who had not experienced the same consequences. CONCLUSIONS: Experience with consequences is associated with more positive evaluations of those consequences. Therefore, it may be important to consider individuals' experiences with, and evaluations of, alcohol-related consequences in college student drinking interventions.

The Valued Living Questionnaire for Alcohol Use: Measuring value-behavior discrepancy in college student drinking.

Developing discrepancy between one's values and behaviors is theoretically important in motivating change; however, existing studies lack a validated measure of value-behavior discrepancy for alcohol misuse. The current studies aimed to modify Wilson & DuFrene (2008) Valued Living Questionnaire (VLQ) to assess consistency of alcohol use with important values. In Study 1, the initial factor structure and test-retest reliability of the VLQ for Alcohol Use (VLQ-A) was tested in a sample of college students who regularly drink alcohol (N = 150). Results guided modifications to the measure. In Study 2, the revised measure's factor structure and predictive validity were tested with a second sample of college students who drink alcohol (N = 222). In both studies, exploratory factor analysis supported a unidimensional factor structure. Perceived discrepancy between alcohol use and important values predicted greater readiness to change, while perceived consistency between alcohol use and important values predicted more frequent heavy episodic drinking. Certain values were more useful in predicting outcomes than others. Alcohol use (heavy vs. moderate drinking) did not moderate outcomes. The VLQ-A is a brief and reliable self-report measure of perceived discrepancy between drinking behaviors and important values that may increase readiness to change. Future research examining the generalizability of findings to various samples and the efficacy of the VLQ-A as a supplement to brief interventions is warranted. (PsycINFO Database Record

Normative perceptions of alcohol-related consequences among college students.

College students in the U.S. continue to drink in hazardous ways and experience a range of alcohol-related consequences. Personalized feedback interventions (PFIs), which often include normative components comparing personal drinking to that of similar peers, have been effective in reducing alcohol outcomes among college students. Though normative perceptions of the quantity and frequency of alcohol use have been examined in many studies, norms for alcohol-related consequences have received less attention. The current study examined self-other discrepancies (SODs) for alcohol-related consequences among college students. Participants overestimated how often alcohol-related consequences are experienced by other same-sex students on campus and rated consequences as more acceptable for others to experience than themselves. No differences in SODs were found between those who did and did not report alcohol use. Future studies should examine the efficacy of PFIs that incorporate normative feedback on alcohol-related consequences.

Enhancing the efficacy of computerized feedback interventions for college alcohol misuse: An exploratory randomized trial.

OBJECTIVE: Personalized feedback interventions (PFIs) have been associated with decreased alcohol consumption and related problems among college students; however, the necessary and sufficient components responsible for efficacy remain unclear. The present study investigated the relative efficacy of 3 computerized PFIs with differing content, the content-specific mechanisms of change within PFIs, and the moderating roles of comparison orientation and baseline risk in intervention outcomes. METHOD: College students (N = 212) reporting alcohol use in a typical week completed an assessment prior to randomization (norms PFI, enhanced PFI, choice PFI, assessment only) and 1 month postintervention. RESULTS: Participants who received a PFI reported greater decreases in alcohol use, peak blood alcohol concentration (BAC), related problems, and perceptions of typical students' drinking than those in the control group. Neither tendency to compare oneself with others nor baseline risk moderated outcomes. PFIs influenced weekly alcohol use indirectly through changes in descriptive normative perceptions and alcohol-related consequences indirectly through changes in peak BAC. CONCLUSIONS: Computerized PFIs are more effective than assessment alone in decreasing alcohol use and related problems among college students. Normative comparisons may be sufficient to elicit behavior change, and inclusion of select additional components may not yield significant improvements in outcomes. However, the consistent benefit of including feedback on physical and monetary costs of drinking and moderation strategies, although nonsignificant, may warrant the negligible increase in time and money required to provide such information electronically. Computerized PFIs seem to be an ideal first step to the prevention and treatment of college alcohol misuse.

Is elderspeak appropriate? A survey of certified nursing assistants.

Elderspeak is a form of patronizing speech that is sometimes used with older adults and can result in unintended negative consequences. Certified nursing assistants (CNAs) working in long-term care facilities may be particularly prone to using elderspeak because they frequently interact with vulnerable and frail older adults who require assistance with activities of daily living. The purpose of the current study was to assess contextual variables that may prompt the use of elderspeak by CNAs. One hundred thirty-four CNAs completed a 36-item questionnaire intended to determine their evaluations of the appropriateness of elderspeak in a variety of contexts. Results indicated that specific resident-related variables (e.g., age, cognitive impairment) and situational variables (e.g., the absence of others during a CNA-resident interaction) were associated with higher ratings of appropriateness of elderspeak. These findings may have implications for improving communication training for CNAs.

A computer-based feedback only intervention with and without a moderation skills component.

Research on the efficacy of computer-delivered feedback-only interventions (FOIs) for college alcohol misuse has been mixed. Limitations to these FOIs include participant engagement and variation in the use of a moderation skills component. The current investigation sought to address these limitations using a novel computer-delivered FOI, the Drinkers Assessment and Feedback Tool for College Students (DrAFT-CS). Heavy drinking college students (N=176) were randomly assigned to DrAFT-CS, DrAFT-CS plus moderation skills (DrAFT-CS+), moderation skills only (MSO), or assessment only (AO) group, and were assessed at 1-month follow-up (N=157). Participants in the DrAFT-CS and DrAFT-CS+groups reported significantly lower estimated blood alcohol concentrations (eBACs) on typical heaviest drinking day than participants in the AO group. The data also supported the incorporation of a moderation skills component within FOIs, such that participants in DrAFT-CS+group reported significantly fewer drinks per week and drinks per heaviest drinking occasion than participants in the AO group.