The results of clinician-focused implementation strategies on uptake and outcomes of Measurement-Based Care (MBC) in general mental health care.

BACKGROUND: Measurement-Based Care (MBC) is the routine administration of measures, clinicians' review of the feedback and discussion of the feedback with their clients, and collaborative evaluation of the treatment plan. Although MBC is a promising way to improve outcomes in clinical practice, the implementation of MBC faces many barriers, and its uptake by clinicians is low. The purpose of this study was to investigate whether implementation strategies that were developed with clinicians and aimed at clinicians had an effect on (a) clinicians' uptake of MBC and (b) clients' outcomes of MBC. METHODS: We used an effectiveness-implementation hybrid design based on Grol and Wensing's implementation framework to assess the impact of clinician-focused implementation strategies on both clinicians' uptake of MBC and outcomes obtained with MBC for clients in general mental health care. We hereby focused on the first and second parts of MBC, i.e., the administration of measures and use of feedback. Primary outcome measures were questionnaire completion rate and discussion of the feedback with clients. Secondary outcomes were treatment outcome, treatment length, and satisfaction with treatment. RESULTS: There was a significant effect of the MBC implementation strategies on questionnaire completion rate (one part of clinicians' uptake), but no significant effect on the amount of discussion of the feedback (the other part of clinicians' uptake). Neither was there a significant effect on clients' outcomes (treatment outcome, treatment length, and satisfaction with treatment). Due to various study limitations, the results should be viewed as exploratory. CONCLUSIONS: Establishing and sustaining MBC in real-world general mental health care is complex. This study helps to disentangle the effects of MBC implementation strategies on differential clinician uptake, but the effects of MBC implementation strategies on client outcomes need further examination.

Psychometric properties of the Dutch version of the Evidence-Based Practice Attitude Scale (EBPAS).

BACKGROUND: The Evidence-Based Practice Attitude Scale (EBPAS) was developed in the United States to assess attitudes of mental health and welfare professionals toward evidence-based interventions. Although the EBPAS has been translated in different languages and is being used in several countries, all research on the psychometric properties of the EBPAS within youth care has been carried out in the United States. The purpose of this study was to investigate the psychometric properties of the Dutch version of the EBPAS. METHODS: After translation into Dutch, the Dutch version of the EBPAS was examined in a diverse sample of 270 youth care professionals working in five institutions in the Netherlands. We examined the factor structure with both exploratory and confirmatory factor analyses and the internal consistency reliability. We also conducted multiple linear regression analyses to examine the association of EBPAS scores with professionals' characteristics. It was hypothesized that responses to the EBPAS items could be explained by one general factor plus four specific factors, good to excellent internal consistency reliability would be found, and EBPAS scores would vary by age, sex, and educational level. RESULTS: The exploratory factor analysis suggested a four-factor solution according to the hypothesized dimensions: Requirements, Appeal, Openness, and Divergence. Cronbach's alphas ranged from 0.67 to 0.89, and the overall scale alpha was 0.72. The confirmatory factor analyses confirmed the factor structure and suggested that the lower order EBPAS factors are indicators of a higher order construct. However, Divergence was not significantly correlated with any of the subscales or the total score. The confirmatory bifactor analysis endorsed that variance was explained both by a general attitude towards evidence-based interventions and by four specific factors. The regression analyses showed an association between EBPAS scores and youth care professionals' age, sex, and educational level. CONCLUSIONS: The present study provides strong support for a structure with a general factor plus four specific factors and internal consistency reliability of the Dutch version of the EBPAS in a diverse sample of youth care professionals. Hence, the factor structure and reliability of the original version of the EBPAS seem generalizable to the Dutch version of the EBPAS.

The Associations between Structural Treatment Characteristics and Post-Treatment Functioning in Compulsory Residential Youth Care.

BACKGROUND: In 2005 a new compulsory residential treatment program was developed for adolescents in need for protection against themselves or their environment. OBJECTIVE: The aim of the present study was to examine the association of structural treatment characteristics of this new residential treatment program (i.e., duration of treatment, discharge status, and group composition in terms of sex) with post-treatment functioning. Additionally, the number of pre-treatment risk factors was included in the model. METHOD: A total of 301 adolescents (174 boys, 127 girls), with a mean age at time of admittance of 15.50 (SD = 1.26) participated in this study. The number of risk factors was derived from treatment files of the adolescents at time of entrance. Six months after discharge, adolescents participated in a telephone interview to measure ten post-treatment variables indicating how well they were doing. RESULTS: The results showed that duration of treatment was related to post-treatment living situation, in that adolescents who were in treatment for shorter durations were more likely to live on their own after treatment. For discharge status, findings suggested that adolescents who were regularly discharged had more frequent contact with their family; however, they also showed higher alcohol consumption 6 months after treatment. Group composition was related to the girls' official offending, indicating that girls placed in mixed-sex groups showed significantly fewer official police contacts than did girls in girls-only treatment groups. CONCLUSION: Overall, structural treatment characteristics were hardly related to the adolescents' functioning after treatment. Suggestions for future research are discussed.

The role of acquaintanceship in the perception of child behaviour problems.

The role of acquaintanceship with the child on reports of child behaviour by different informants was examined within the framework of a general theory of personality judgment. Mothers of referred children and group-care workers rated videotaped behaviour samples of a well known and an unknown child in the clinic. Independent observers also rated the videotapes. In line with the acquaintanceship hypothesis, mothers were found to perceive more behaviour problems than independent observers when rating well known children but not unknown children. Contrary to the acquaintanceship hypothesis, however, the group-care workers in our study reported more behaviour problems than the other informants regardless of their acquaintance with the children. The clinical and methodological implications of these findings are discussed.

Degrees of freedom and degrees of certainty: a developmental model for the establishment of evidence-based youth care.

There are many psychosocial interventions for children and adolescents. The effects of these interventions in day-to-day practice are nevertheless often unclear. Researchers typically take the randomized controlled trial (RCT) as the "gold standard" for the supply of evidence regarding the effectiveness of an intervention. However, such trials are rarely performed in youth care practice because they are difficult to conduct and sometimes meet with ethical objections. RCTs may also be prematurely and thus unnecessarily conducted on interventions that are not yet fully developed or interventions that have yet to be accepted into actual practice. In this article, a four-stage model for the classification and development of effective interventions carried out in actual youth care practice is presented. Stage 1 (potential interventions) requires specification of the core elements of an intervention (e.g., objectives, target groups, activities) and may involve both descriptive and implementation studies. Stage 2 (plausible interventions) requires the explication of an underlying intervention theory (e.g., what works with whom and why) and may involve both literature reviews and techniques to elicit the knowledge of experts. Stage 3 (functional interventions) requires preliminary evidence that the intervention works in actual practice and may involve client satisfaction studies, goal attainment studies, pre-post test studies, quality control studies, benchmark studies, correlational studies, and quasi-experimental studies. Stage 4 (efficacious interventions) requires clear evidence that the intervention is responsible for the observed effects and may involve RCTs and well-designed repeated case studies.

The impact of the big five personality traits on reports of child behavior problems by different informants.

The present study compared ratings of a standardized sample of child behavior problems across informants and examined the effects of informant personality traits on child behavior ratings by mothers, teachers, and group-care workers. Participants were 55 clinic-referred children, aged 6-12 years. All informants watched and rated the same 17-min videotaped behavior sample of a familiar target child. Independent trained observers rated the same videotapes to provide criterion ratings. Informants' personality traits were assessed using the NEO Five Factor Personality Inventory. Results showed that mothers reported fewer behavior problems than did the professionals, that the informants who were familiar with the child reported more behavior problems than did the independent observers, and that higher levels of informant neuroticism were related to higher ratings of child behavior problems in the case of the professionals, but not in the case of the mothers. In addition, group-care workers who were less extraverted and open were likely to report more child behavior problems than group-care workers with normal levels of extraversion and openness. Finally, no relations were found between agreeableness or conscientiousness and ratings of child behavior. Findings suggest that professionals who work with children are not immune to distortions based on their own personality.

Emotions in social information processing and their relations with reactive and proactive aggression in referred aggressive boys.

We studied emotional aspects of social information processing (SIP) and their specific relations with reactive and proactive aggression in 54 boys ages 7 to 13 who had been referred for aggressive behavior problems and a comparison group. Participants listened to vignettes concerning provocations by peers and answered questions concerning SIP, own and peer's emotions, and emotion regulation. Aggressive boys attributed more hostile intent, happiness, and less guilt; reported more anger; mentioned less adaptive emotion-regulation strategies; generated more aggressive responses; and evaluated aggressive responses less negatively than comparison boys. Hypothesized specific relations with reactive and proactive aggression were found, except for emotion regulation that was negatively related with both kinds of aggression. Potentially confounding effects of socially desirable answering, verbal intelligence, and recall of vignettes were controlled for.

Implemented as intended? Recording family worker activities in a Families First program.

In evaluating family preservation services, it is important not only to study the service outcomes and the family characteristics, but also what actually happens during the treatment. This requires a program model. This article describes how a program model works, prescribes how workers should carry it out, and describes how researchers should measure the program's characteristics. The authors use data from Families First in The Netherlands to test the model. Results show that the method of the program meets the specified characteristics. The results are important for treatment, policy, education, and evaluation research.

Mental health problems of deaf Dutch children as indicated by parents' responses to the child behavior checklist.

Emotional/behavioral problems of 238 deaf Dutch children ages 4-18 years were studied. Parental reports indicated that 41% had emotional/behavioral problems, a rate nearly 2.6 times higher than the 16% reported by parents of a Dutch normative sample. Mental health problems seemed most prevalent in families with poor parent-child communication. Deaf children ages 12-18 showed more problems with anxiety and depression and more social problems than those ages 4-11. Deaf children with relatively low intelligence showed more social problems, thought problems, and attention problems than those with relatively high intelligence. The authors stress the need to get information on deaf children's mental health functioning not just from parents but from other informants such as teachers and the children themselves. An expansion assessment of deaf children, and of special services and treatments for deaf children and adolescents with emotional/behavioral problems, is recommended.

Negative feelings exacerbate hostile attributions of intent in highly aggressive boys.

Tested the hypothesis that aggressive boys' tendency to attribute hostile intentions to peers is exacerbated in a negative emotional state. Twenty-nine highly aggressive boys in special education, 12 moderately aggressive boys in regular education, and 16 nonaggressive boys in regular education inferred peers' intentions in 8 vignettes concerning ambiguous provocation by peers. Mild negative emotions were induced by unjust loss of a manipulated computer game. Half the vignettes were completed in this negative emotional state. After completion of all vignettes, the game was played again and won to reinduce positive feelings. Self-ratings of feelings obtained throughout the study showed the manipulations consecutively induced negative and positive feelings. Negative feelings increased hostile attribution of intent in the highly aggressive group. Highly and moderately aggressive boys responded more aggressively than nonaggressive boys.

The implementation of families first in The Netherlands: a one year follow-up.

This study examined whether the American family preservation program Families First was successfully implemented in The Netherlands. Data were collected on 250 children of 177 families who received Families First. At the start of treatment 78% of the children appeared to have serious behavioral problems, 67% of the parents experienced a high level of parental stress, and 63% of the children went through a substantial number of life events during the year preceding the treatment. On average the treatments had the intended duration (about 4 weeks), intensity (about 10 hours a week) and availability (during working hours as well as in evenings and in weekends), and family workers did adhere to important guidelines of treatment delivery. One year after treatment 76% of the children were still living at home. Moreover, children's behavioral problems, parental stress and the number of life events turned out to be significantly decreased. It was concluded that Families First had reached its intended target group, delivered the treatment as intended, and achieved its intended outcomes, suggesting a successful implementation in The Netherlands.

Negative Feelings Exacerbate Hostile Attributions of Intent in Highly Aggressive Boys.

Tested the hypothesis that aggressive boys' tendency to attribute hostile intentions to peers is exacerbated in a negative emotional state. Twenty-nine highly aggressive boys in special education, 12 moderately aggressive boys in regular education, and 16 nonaggressive boys in regular education inferred peers' intentions in 8 vignettes concerning ambiguous provocation by peers. Mild negative emotions were induced by unjust loss of a manipulated computer game. Half the vignettes were completed in this negative emotional state. After completion of all vignettes, the game was played again and won to reinduce positive feelings. Self-ratings of feelings obtained throughout the study showed the manipulations consecutively induced negative and positive feelings. Negative feelings increased hostile attribution of intent in the highly aggressive group. Highly and moderately aggressive boys responded more aggressively than nonaggressive boys.

Hostile attribution of intent and aggressive behavior: a meta-analysis.

A meta-analytic review was conducted to explain divergent findings on the relation between children's aggressive behavior and hostile attribution of intent to peers. Forty-one studies with 6,017 participants were included in the analysis. Ten studies concerned representative samples from the general population, 24 studies compared nonaggressive to extremely aggressive nonreferred samples, and 7 studies compared nonreferred samples with children referred for aggressive behavior problems. A robust significant association between hostile attribution of intent and aggressive behavior was found. Effect sizes differed considerably between studies. Larger effects were associated with more severe aggressive behavior, rejection by peers as one of the selection criteria, inclusion of 8- to-12-year-old participants, and absence of control for intelligence. Video and picture presentation of stimuli were associated with smaller effect sizes than was audio presentation. Staging of actual social interactions was associated with the largest effects. The importance of understanding moderators of effect size for theory development is stressed.