Development and preliminary validation of the Brief Self-Compassion Inventory.

Research and clinical interest in self-compassion has grown due to its associations with physical and mental health benefits. Widely used measures of self-compassion have conceptual and psychometric limitations that warrant attention. The purpose of this project was to develop a new self-compassion measure, the Brief Self-Compassion Inventory (BSCI), and test its psychometric properties. We developed items for the BSCI based on theory, prior research, and expert and cancer patient feedback. The BSCI was then tested with adults diagnosed with breast, gastrointestinal, lung, or prostate cancer (N = 404). Confirmatory factor analysis suggested a unidimensional structure, and internal consistency reliability was excellent. Construct validity of the BSCI was established through its correlations with psychological variables hypothesized to be related to self-compassion, such as mindfulness, acceptance of cancer, and other coping strategies. Furthermore, measurement invariance testing of the BSCI indicated that it could be used across patients of varying genders, cancer types, and stages of illness. In conclusion, the 5-item BSCI was determined to be psychometrically sound and suitable for use with adults of varying genders, cancer types, and stages of disease. The measure warrants testing with other medical and nonclinical populations.

Individualized Education Program Quality for Transition Age Students with Autism.

BACKGROUND: Students with ASD have some of the worst postsecondary outcomes when compared to other students with disabilities indicating transition planning may not be working effectively. One source of support for postsecondary planning is development of the transition Individualized Education Program (IEP). However, little research is available to describe the current contents of transition IEPs for students with ASD. This study aimed to describe IEP and postsecondary planning quality for students with autism in their final year of high school. METHOD: IEPs for 20 students with autism (Mage = 18.2 years; SD = 1.1) from two mid-southern states were analyzed. Descriptive analyses were used to identify strengths and weaknesses of IEPs and postsecondary goals based on federal law requirements and best practice recommendations. RESULTS: IEPs contained an average of 3.1 IEP goals and 1.6 postsecondary goals. IEP goals were most frequently related to academic, learning/work, or communication skills. All IEPs contained an employment postsecondary goal while less than half of the IEPs included an independent living postsecondary goal. Key findings include lack of goals related to social skills and the lack of alignment between present levels of performance, IEP goals, and postsecondary goals. CONCLUSIONS: IEPs for students with ASD in their final year of school do not consistently meet standards outlined by federal law or best practice recommendations necessary for successful transition from high school.

Implementation Fidelity and Common Elements of High Quality Teaching Sequences for Students with Autism Spectrum Disorder in COMPASS.

BACKGROUND: Evidence-based educational instruction includes teaching elements common across different approaches as well as specific elements of the chosen evidence-based practice. We were interested in evaluating the use and impact of common elements of teaching. Specifically, we adopted a model of elements of high quality teaching sequences and developed and tested an instructional quality index to capture evidence-based features within teaching sequences (Grisham-Brown & Ruble, 2014). METHOD: The current investigation examined 29 special education teachers who received a consultation intervention called the Collaborative Model for Promoting Competence and Success (COMPASS; Ruble, Dalrymple & McGrew, 2012) that results in personalized teaching plans for young students with ASD and embeds elements of evidence-based teacher coaching of self-reflection and performance-based feedback. We analyzed the teaching plans to understand which of the common elements were present, and if teachers demonstrated improved performance after coaching. RESULTS: Analysis of the use of common elements during the first and fourth coaching session demonstrated that all teachers showed improvement. Most importantly, the use of common elements correlated with student goal attainment outcomes. CONCLUSIONS: These results suggest that common elements of teaching sequences which we view as core features of teaching quality, can be improved as a result of coaching, and most importantly, are associated with students' educational outcomes.

Stakeholder perspectives on transition planning, implementation, and outcomes for students with autism spectrum disorder.

LAY ABSTRACT: Little is known about factors impacting poor post-school outcomes for transition-age students with autism spectrum disorder. Guided by an implementation science framework that takes into account the multiple factors that influence transition outcomes, we sought to better understand the interdependent impacts of policy, organizational, provider, and individual factors that shape the transition planning process in schools, and the subsequent process through which transition plans are implemented as youth with autism spectrum disorder access services and gain employment after school. We conducted focus groups with individuals with autism spectrum disorder, parents, classroom teachers, school administrators, adult service providers, and state policymakers (10 groups, N = 40). Participants described how core tenets of the individualized education planning process were not reliably implemented: planning was described by inappropriate goal-setting, ineffective communication, and inadequate involvement of all decision-makers needed to inform planning. After school, youth struggled to access the services specified in their transition plans due to inadequate planning, overburdened services, and insufficient accountability for adult service providers. Finally, a failure to include appropriate skill-building and insufficient interagency and community relationships limited efforts to gain and maintain employment. Diverse stakeholder perspectives illuminate the need for implementation efforts to target the provider, organizational, and policy levels to improve transition outcomes for individuals with autism spectrum disorder.

Effects of Caregiver-Focused Programs on Psychosocial Outcomes in Caregivers of Individuals with ASD: A Meta-analysis.

The current meta-analysis comprehensively reviewed group-design studies of interventions designed to improve ASD caregiver psychosocial outcomes and explored potential moderators of effectiveness. Forty-one unique studies targeting 1771 caregivers met inclusion criteria. Overall, the interventions had a small positive effect in improving psychosocial outcomes in caregivers of individuals with ASD (within-subjects: Hedges' g = .44; between-subjects: Hedges' g = .28). Most intervention approaches demonstrated some evidence of effectiveness. Acceptance and commitment therapy, mindfulness-based interventions, and cognitive behavioral treatments demonstrated the strongest impact in improving caregiver psychosocial outcomes in pre-post comparisons. Although the results provide preliminary support for the effectiveness of caregiver-focused interventions, more studies with larger sample sizes, rigorous research designs, and long-term follow-up assessments are needed.

A Preliminary Study of Parent Activation, Parent-Teacher Alliance, Transition Planning Quality, and IEP and Postsecondary Goal Attainment of Students with ASD.

The school, student and family factors underlying poor postsecondary outcomes of students with autism spectrum disorder (ASD) are not well understood. The potential impact of school [e.g., transition planning quality (TPQ)], family (e.g., parent activation), and student factors (e.g., adaptive functioning) and their interaction (e.g., parent-teacher alliance) on student outcomes were examined. Student IQ and adaptive behavior, TPQ, and alliance correlated with IEP progress, with postsecondary goal attainment generally and with student participation in training/education, specifically. However, only parent activation and student externalizing behavior correlated with employment. Families and students, rather than school personnel, were the primary persons in charge and in control of the implementation of postsecondary plans and required help across multiple coaching sessions to implement plans fully.

Behavioral Health Service Utilization Among Detained Adolescents: A Meta-Analysis of Prevalence and Potential Moderators.

PURPOSE: Utilization of behavioral health treatment services among adolescents who have been detained or incarcerated within the juvenile justice system is poorly understood, with estimated utilization rates varying widely across studies. This meta-analysis was conducted to review and synthesize the literature on the prevalence of service utilization among this population. METHODS: Data from 27 studies of 28 distinct samples were abstracted and coded. A meta-analysis was conducted to calculate individual prevalence estimates of behavioral health service utilization, which were combined using random effects models. A moderator analysis was also conducted. RESULTS: Prevalence effect sizes (pr) for service utilization were low, with effect sizes pr = 33.1% for mental health services, pr = 27.95% for substance use-related services, and pr = 45.32% for unspecified services. The moderator analysis showed significant heterogeneity in prevalence of behavioral health service utilization. CONCLUSIONS: The findings suggest limited service utilization by adolescents who had been detained or incarcerated, whether assessed before, during, or after confinement. Future research should focus on assessing the quality of, and youth access to, behavioral health services within and outside of juvenile justice facilities. Improved programs to ensure consistent treatment for previously detained or incarcerated adolescents are warranted.

Adapting COMPASS for youth with ASD to improve transition outcomes using implementation science.

Implementation science provides guidance on adapting existing evidence based practices (EBPs) by incorporating implementation concerns from the start. Focus-group methodology was used to understand barriers and facilitators of transition planning and implementation for students with autism spectrum disorder (ASD) who often experience disparate postsecondary outcomes compared to peers. Results were used to modify an evidence-based consultation intervention originally applied to young students with ASD, called the Collaborative Model for Promoting Competence and Success (COMPASS; Ruble, Dalrymple, & McGrew, 2012). Because consultation is a multilevel EBP, two existing implementation science frameworks were used to guide adaptation: the Framework for Evidence Based Implementation and Intervention Practices (Dunst & Trivette, 2012) and the Consolidated Framework for Implementation Research (Damschroder et al., 2009). The purpose of this article is to describe a process of adaptation of COMPASS that may be useful for other implementation science studies of consultation interventions, teacher acceptability, feasibility, and burden, and parent/student satisfaction with the adapted intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Randomized Control Trial of COMPASS for Improving Transition Outcomes of Students with Autism Spectrum Disorder.

The postsecondary outcomes of individuals with autism spectrum disorder (ASD) are significantly worse than peers with other disabilities. One problem is the lack of empirically-supported transition planning interventions to guide services and help produce better outcomes. We applied an implementation science approach to adapt and modify an evidence-based consultation intervention originally tested with young children called the Collaborative Model for Promoting Competence and Success (COMPASS; Ruble et al., The collaborative model for promoting competence and success for students with ASD. Springer, New York, 2012a) and evaluate it for efficacy in a randomized controlled trial for transition-age youth. Results replicated findings with younger students with ASD that IEP outcomes were higher for COMPASS compared to the placebo control group (d = 2.1). Consultant fidelity was high and teacher adherence improved over time, replicating the importance of ongoing teacher coaching.

An empirical study of multidimensional fidelity of COMPASS consultation.

Consultation is essential to the daily practice of school psychologists (National Association of School Psychologist, 2010). Successful consultation requires fidelity at both the consultant (implementation) and consultee (intervention) levels. We applied a multidimensional, multilevel conception of fidelity (Dunst, Trivette, & Raab, 2013) to a consultative intervention called the Collaborative Model for Promoting Competence and Success (COMPASS) for students with autism. The study provided 3 main findings. First, multidimensional, multilevel fidelity is a stable construct and increases over time with consultation support. Second, mediation analyses revealed that implementation-level fidelity components had distant, indirect effects on student Individualized Education Program (IEP) outcomes. Third, 3 fidelity components correlated with IEP outcomes: teacher coaching responsiveness at the implementation level, and teacher quality of delivery and student responsiveness at the intervention levels. Implications and future directions are discussed. (PsycINFO Database Record

Job burnout in mental health providers: A meta-analysis of 35 years of intervention research.

Burnout is prevalent among mental health providers and is associated with significant employee, consumer, and organizational costs. Over the past 35 years, numerous intervention studies have been conducted but have yet to be reviewed and synthesized using a quantitative approach. To fill this gap, we performed a meta-analysis on the effectiveness of burnout interventions for mental health workers. We completed a systematic literature search of burnout intervention studies that spanned more than 3 decades (1980 to 2015). Each eligible study was independently coded by 2 researchers, and data were analyzed using a random-effects model with effect sizes based on the Hedges' g statistic. We computed an overall intervention effect size and performed moderator analyses. Twenty-seven unique samples were included in the meta-analysis, representing 1,894 mental health workers. Interventions had a small but positive effect on provider burnout (Hedges' g = .13, p = .006). Moderator analyses suggested that person-directed interventions were more effective than organization-directed interventions at reducing emotional exhaustion (Qbetween = 6.70, p = .010) and that job training/education was the most effective organizational intervention subtype (Qbetween = 12.50, p < .001). Lower baseline burnout levels were associated with smaller intervention effects and accounted for a significant proportion of effect size variability. The field has made limited progress in ameliorating mental health provider burnout. Based on our findings, we suggest that researchers implement a wider breadth of interventions that are tailored to address unique organizational and staff needs and that incorporate longer follow-up periods. (PsycINFO Database Record

Special Education Teachers' Perceptions and Intentions Toward Data Collection.

Although data-based decision making is an evidence-based practice, many special educators have difficulty applying the practice within daily routines. We applied the Theory of Planned Behavior (TPB) to understand the influences that promote or hinder early childhood special educators' intentions to collect data. We assessed three influences on behavioral intention to collect data derived from the TPB: (a) attitude toward collecting data, (b) social norms for collecting data, and (c) perceived behavioral control for collecting data. All three influences correlated positively with teachers' reported intention to collect data; however, only perceived behavioral control of barriers correlated positively with actual data collection. Additional measures of teacher self-efficacy and administrative support correlated positively with intention to collect data, but not with actual data collection behaviors. Perceived behavior control accounted for the most variance in actual data collection behavior. Implications of the findings for data collection practices in educational settings are discussed.

The Stigma Resistance Scale: A multi-sample validation of a new instrument to assess mental illness stigma resistance.

Although associated with key recovery outcomes, stigma resistance remains under-studied largely due to limitations of existing measures. This study developed and validated a new measure of stigma resistance. Preliminary items, derived from qualitative interviews of people with lived experience, were pilot tested online with people self-reporting a mental illness diagnosis (n = 489). Best performing items were selected, and the refined measure was administered to an independent sample of people with mental illness at two state mental health consumer recovery conferences (n = 202). Confirmatory factor analyses (CFA) guided by theory were used to test item fit, correlations between the refined stigma resistance measure and theoretically relevant measures were examined for validity, and test-retest correlations of a subsample were examined for stability. CFA demonstrated strong fit for a 5-factor model. The final 20-item measure demonstrated good internal consistency for each of the 5 subscales, adequate test-retest reliability at 3 weeks, and strong construct validity (i.e., positive associations with quality of life, recovery, and self-efficacy, and negative associations with overall symptoms, defeatist beliefs, and self-stigma). The new measure offers a more reliable and nuanced assessment of stigma resistance. It may afford greater personalization of interventions targeting stigma resistance.

Consumer factors predicting level of treatment response to illness management and recovery.

OBJECTIVE: This study aims to identify consumer-level predictors of level of treatment response to illness management and recovery (IMR) to target the appropriate consumers and aid psychiatric rehabilitation settings in developing intervention adaptations. METHOD: Secondary analyses from a multisite study of IMR were conducted. Self-report data from consumer participants of the parent study (n = 236) were analyzed for the current study. Consumers completed prepost surveys assessing illness management, coping, goal-related hope, social support, medication adherence, and working alliance. Correlations and multiple regression analyses were run to identify self-report variables that predicted level of treatment response to IMR. RESULTS: Analyses revealed that goal-related hope significantly predicted level of improved illness self-management, F(1, 164) = 10.93, p < .001, R2 = .248, R2 change = .05. Additionally, we found that higher levels of maladaptive coping at baseline were predictive of higher levels of adaptive coping at follow-up, F(2, 180) = 5.29, p < .02, R2 = .38, R2 change = .02. Evidence did not support additional predictors. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Previously, consumer-level predictors of level of treatment response have not been explored for IMR. Although 2 significant predictors were identified, study findings suggest more work is needed. Future research is needed to identify additional consumer-level factors predictive of IMR treatment response in order to identify who would benefit most from this treatment program. (PsycINFO Database Record

Comparing the Costs and Acceptability of Three Fidelity Assessment Methods for Assertive Community Treatment.

Successful implementation of evidence-based practices requires valid, yet practical fidelity monitoring. This study compared the costs and acceptability of three fidelity assessment methods: on-site, phone, and expert-scored self-report. Thirty-two randomly selected VA mental health intensive case management teams completed all fidelity assessments using a standardized scale and provided feedback on each. Personnel and travel costs across the three methods were compared for statistical differences. Both phone and expert-scored self-report methods demonstrated significantly lower costs than on-site assessments, even when excluding travel costs. However, participants preferred on-site assessments. Remote fidelity assessments hold promise in monitoring large scale program fidelity with limited resources.

The Relationship Between Provider Competence, Content Exposure, and Consumer Outcomes in Illness Management and Recovery Programs.

Provider competence may affect the impact of a practice. The current study examined this relationship in sixty-three providers engaging in Illness Management and Recovery with 236 consumers. Improving upon previous research, the present study utilized a psychometrically validated competence measure in the ratings of multiple Illness Management and Recovery sessions from community providers, and mapped outcomes onto the theory underlying the practice. Provider competence was positively associated with illness self-management and adaptive coping. Results also indicated baseline self-management skills and working alliance may affect the relationship between competence and outcomes.

Too Stressed to Teach? Teaching Quality, Student Engagement, and IEP Outcomes.

Teacher stress and burnout have a detrimental effect on the stability of the teaching workforce. However, the possible consequences of teacher burnout on teaching quality and on student learning outcomes are less clear, especially in special education settings. We applied Maslach and Leiter's model (1999) to understand the direct effects of burnout on teaching in general and stress arising from interaction with a specific student on the IEP outcomes of young children with autism spectrum disorder. We also examined indirect effects through teaching quality and student engagement. The results indicated that one of the three components of burnout-teacher personal accomplishment-was directly related to IEP outcomes, a distal effect, whereas stress was directly related to teaching quality and student engagement, which were more proximal effects. Additionally, teacher stress, emotional exhaustion, and depersonalization had indirect effects on IEP outcomes through teaching quality and student engagement.

Illness management and recovery in community practice.

OBJECTIVE: To examine provider competence in providing Illness Management and Recovery (IMR), an evidence-based self-management program for people with severe mental illness, and the association between implementation supports and IMR competence. METHOD: IMR session recordings, provided by 43 providers/provider pairs, were analyzed for IMR competence using the IMR Treatment Integrity Scale. Providers also reported on receipt of commonly available implementation supports (e.g., training, consultation). RESULTS: Average IMR competence scores were in the "needs improvement" range. Clinicians demonstrated low competence in several IMR elements: significant other involvement, weekly action planning, action plan follow-up, cognitive-behavioral techniques, and behavioral tailoring for medication management. These elements were commonly absent from IMR sessions. Competence in motivational enhancement strategies and cognitive-behavioral techniques differed based on the module topic covered in a session. Generally, receipt of implementation supports was not associated with increased competence; however, motivational interviewing training was associated with increased competence in action planning and review. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: IMR, as implemented in the community, may lack adequate competence and commonly available implementation supports do not appear to be adequate. Additional implementation supports that target clinician growth areas are needed. (PsycINFO Database Record

Stress in Parents of Children with Autism Spectrum Disorder: An Exploration of Demands and Resources.

We applied the ABCX model of stress and coping to assess the association between child and family demands, school-based resources (i.e., parent-teacher alliance and COMPASS, a consultation intervention), and two measures of parent stress: perceptions of the demands of raising a child (Child domain) and reactions to those demands (Parent domain). Data were analyzed from seventy-nine parents of children ages 3-9 with ASD participating in two randomized controlled trials of COMPASS. Stronger parent-teacher alliance correlated with decreased Parent domain stress and participation in COMPASS correlated with decreased Child domain stress after controlling for baseline stress. The study indicates that school-based resources can help reduce parent stress.

Comparison of Assertive Community Treatment Fidelity Assessment Methods: Reliability and Validity.

Assertive community treatment is known for improving consumer outcomes, but is difficult to implement. On-site fidelity measurement can help ensure model adherence, but is costly in large systems. This study compared reliability and validity of three methods of fidelity assessment (on-site, phone-administered, and expert-scored self-report) using a stratified random sample of 32 mental health intensive case management teams from the Department of Veterans Affairs. Overall, phone, and to a lesser extent, expert-scored self-report fidelity assessments compared favorably to on-site methods in inter-rater reliability and concurrent validity. If used appropriately, these alternative protocols hold promise in monitoring large-scale program fidelity with limited resources.