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2.
Artigo em Inglês | MEDLINE | ID: mdl-38676872

RESUMO

Positive organizational climate - employee perceptions of their work environment and the impact of this environment on well-being and functioning - is associated with desirable organizational and client-level outcomes in mental health organizations. Clinical supervisors are well-positioned to impact organizational climate, as they serve as intermediaries between higher-level administrators who drive the policies and procedures and the therapists impacted by such decisions. This cross-sectional study examined the role of clinical supervisors as drivers of therapist perceptions of organizational climate within supervisory teams. Specifically, the present study investigated: (1) shared perceptions of organizational climate among therapists on the same supervisory team; (2) predictors of therapist climate perceptions. Eighty-six therapists were supervised by 22 supervisors. Indices of interrater agreement and interrater reliability of therapists on the same supervisory team were examined to determine shared or distinct perceptions of organizational climate. Multi-level models were used to examine whether supervisor attitudes towards evidence-based practices and therapist perceptions of supervisor communication predicted perceived organizational climate. Results showed perceptions of organizational cohesion and autonomy were shared among therapists on the same supervisory team and distinct from therapists on different supervisory teams. Therapist perceptions of their supervisor's communication was positively associated with perceptions of organizational cohesion and autonomy. These findings align with emerging evidence that middle managers shape their employees' experience of their work environment through communication strategies. These findings also point to the potential for intervening at lower organizational levels to improve overall organizational climate.

3.
Adm Policy Ment Health ; 51(4): 597-609, 2024 07.
Artigo em Inglês | MEDLINE | ID: mdl-38334882

RESUMO

This study explored predictors of community-based providers' adherence to MATCH, a modular cognitive behavioral therapy for children and adolescents. Provider-reported adherence to MATCH was measured using three increasingly strict criteria: (1) session content (whether the session covered MATCH content consistent with the client's target problem), (2) session content and sequencing (whether the session covered MATCH content in the expected sequence for the client's target problem), and (3) session content, sequencing, and participant (whether the session covered MATCH content in the expected sequence and with the expected participant(s) for the client's target problem). Session, client, provider, and organizational predictors of adherence to MATCH were assessed using multilevel modeling. Results revealed that nearly all providers delivered MATCH content that corresponded to the target problem, but only one-third of providers delivered MATCH content in the expected sequence and with the expected participant for the client's target problem. This difference underscores the need for nuanced adherence measurement to capture important implementation information that broad operationalizations of adherence miss. Regardless of the criteria used providers were most adherent to MATCH during sessions when clients presented with interfering comorbid mental health symptoms. This suggests that the design of MATCH, which offers flexibility and structured guidance to address comorbid mental health problems, may allow providers to personalize treatment to address interfering comorbidity symptoms while remaining adherent to evidence-based practices. Additional guidance for providers on managing other types of session interference (e.g., unexpected events) may improve treatment integrity in community settings.


Assuntos
Terapia Cognitivo-Comportamental , Fidelidade a Diretrizes , Humanos , Adolescente , Criança , Feminino , Masculino , Serviços Comunitários de Saúde Mental/organização & administração , Transtornos Mentais/terapia
4.
Adm Policy Ment Health ; 51(2): 268-285, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38261119

RESUMO

This study investigated coded data retrieved from clinical dashboards, which are decision-support tools that include a graphical display of clinical progress and clinical activities. Data were extracted from clinical dashboards representing 256 youth (M age = 11.9) from 128 practitioners who were trained in the Managing and Adapting Practice (MAP) system (Chorpita & Daleiden in BF Chorpita EL Daleiden 2014 Structuring the collaboration of science and service in pursuit of a shared vision. 43(2):323 338. 2014, Chorpita & Daleiden in BF Chorpita EL Daleiden 2018 Coordinated strategic action: Aspiring to wisdom in mental health service systems. 25(4):e12264. 2018) in 55 agencies across 5 regional mental health systems. Practitioners labeled up to 35 fields (i.e., descriptions of clinical activities), with the options of drawing from a controlled vocabulary or writing in a client-specific activity. Practitioners then noted when certain activities occurred during the episode of care. Fields from the extracted data were coded and reliability was assessed for Field Type, Practice Element Type, Target Area, and Audience (e.g., Caregiver Psychoeducation: Anxiety would be coded as Field Type = Practice Element; Practice Element Type = Psychoeducation; Target Area = Anxiety; Audience = Caregiver). Coders demonstrated moderate to almost perfect interrater reliability. On average, practitioners recorded two activities per session, and clients had 10 unique activities across all their sessions. Results from multilevel models showed that clinical activity characteristics and sessions accounted for the most variance in the occurrence, recurrence, and co-occurrence of clinical activities, with relatively less variance accounted for by practitioners, clients, and regional systems. Findings are consistent with patterns of practice reported in other studies and suggest that clinical dashboards may be a useful source of clinical information. More generally, the use of a controlled vocabulary for clinical activities appears to increase the retrievability and actionability of healthcare information and thus sets the stage for advancing the utility of clinical documentation.


Assuntos
Sistemas de Painéis , Serviços de Saúde Mental , Adolescente , Humanos , Criança , Reprodutibilidade dos Testes , Transtornos de Ansiedade , Documentação
5.
J Community Psychol ; 51(7): 2686-2696, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37329566

RESUMO

This community-engaged study aimed to understand effective strategies for disseminating online parenting resources (OPRs) in schools. OPRs were disseminated through seven E-Parenting tips and eight Facebook posts. Facebook posts were viewed a total of 12,404 times, and each post reached an average of 505 people each month. Average engagement rate was 2.41% per post. E-Parenting tips yielded 1514 total clicks, and the average clicks per message was 216.29. E-Parenting tips related to internalizing problems (e.g., anxiety, depression) had a higher click rate than E-Parenting tips related to externalizing problems (e.g., oppositional behavior). OPRs disseminated through Facebook posts, and E-Parenting tips resulted in wide reach and engagement. Different media channels should be utilized to disseminate different OPRs to as many parents as possible.


Assuntos
Poder Familiar , Mídias Sociais , Humanos , Pais , Instituições Acadêmicas
6.
Adm Policy Ment Health ; 50(5): 773-780, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37266799

RESUMO

To improve the dissemination and actionability of mental health research, many mental health professionals have developed online informational resources to increase the general public's awareness of mental health difficulties and available treatments. Yet, limited information exists on the quality and scope of these resources. This study aimed to explore the scope and quantity of online, free, evidence-based mental health resources. Fifty-two mental health professionals nominated 178 resources, which predominantly consisted of homepages and links to more information. When reviewing the original nominations, our team identified an additional 290 resources (e.g., fact sheets linked from a nominated homepage). Of the 468 total nominated resources, 72 were screened out due to not meeting the inclusion criteria of being free (inter-screener reliability = 95%), evidence-based (inter-screener reliability = 94%), and online (inter-screener reliability = 96%). Nominated resources most commonly covered anxiety and obsessive-compulsive disorder (n = 67) and suicide (n = 60). Resources providing information about the mental health problem were most common (n = 210) and resources providing information about immediate help (e.g., hotline) were least common (n = 57). Our findings indicate many free, online, evidence-based resources are available and raise questions of whether efforts to disseminate mental health research are recreating the issue of information overload. Other considerations and future directions for improving the utilization and synthesizing of available resources are discussed.


Assuntos
Saúde Mental , Suicídio , Humanos , Reprodutibilidade dos Testes , Transtornos de Ansiedade , Recursos em Saúde
7.
Annu Rev Clin Psychol ; 19: 51-78, 2023 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-36854287

RESUMO

Cognitive behavioral therapy (CBT) is often referred to as the "gold standard" treatment for mental health problems, given the large body of evidence supporting its efficacy. However, there are persistent questions about the generalizability of CBTs to culturally diverse populations and whether culturally sensitive approaches are warranted. In this review, we synthesize the literature on CBT for ethnic minorities, with an emphasis on randomized trials that address cultural sensitivity within the context of CBT. In general, we find that CBT is effective for ethnic minorities with diverse mental health problems, although nonsignificant trends suggest that CBT effects may be somewhat weaker for ethnic minorities compared to Whites. We find mixed support for the cultural adaptation of CBTs, but evidence for cultural sensitivity training of CBT clinicians is lacking, given a dearth of relevant trials. Based on the limited evidence thus far, we summarize three broad models for addressing cultural issues when providing CBT to diverse populations.


Assuntos
Terapia Cognitivo-Comportamental , Assistência à Saúde Culturalmente Competente , Minorias Étnicas e Raciais , Humanos
8.
Glob Implement Res Appl ; 2(4): 293-304, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36105665

RESUMO

The sudden onset of COVID-19 forced mental health therapists to rapidly transition to telehealth services. While some therapists and organizations were able to achieve an expeditious transition, others struggled. Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, which outlines key phases that guide the implementation process, the current mixed methods study examined what factors predicted the transition to internet-based Parent-Child Interaction Therapy (iPCIT), a telehealth-delivered evidence-based practice (EBP). We investigated two areas related to the transition: (1) if PCIT therapists transitioned to provide iPCIT and (2) if they made this transition quickly. In Fall 2019, 324 therapists completed a survey about implementing PCIT. After stay-at-home orders, 223 of those therapists completed a follow-up survey about their transition to telehealth, organizational characteristics, their caseloads, and telehealth training. The majority of therapists (82%) transitioned to provide iPCIT, with 48% making the transition in less than a week. Open-ended responses indicated that therapists who did not transition-faced challenges related to limited client resources, a lack of training, and organizational delays. Qualitative findings informed predictors for two logistic regression models that are statistical models that predict the probability of an event occurring, with criterion variables (1) whether therapists transitioned to provide iPCIT and (2) whether they transitioned in less than a week. Results showed that caseload in Fall 2019 and receipt of iPCIT training were associated with iPCIT transition. Organizational setting, resiliency, and baseline caseload predicted rapid transition to iPCIT. Implications regarding supporting the implementation of telehealth delivery of EBPs are discussed.

9.
J Community Psychol ; 50(5): 2443-2457, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-34985824

RESUMO

Online parenting programs are an effective way to teach behavioral management skills to parents in the absence of in-person resources. This community-engaged study aimed to examine strategies for disseminating online parenting resources in schools. Online resources were disseminated to parents in a Northern California school district. Dissemination strategies were informed by conversations with school principals, teachers, and parents and considered agent, message, and format. A total of 685 parents and teachers clicked on the online resources: 151 parents and 114 teachers attended synchronous classes. The use of dissemination strategies had a compounding influence on the number of synchronous class attendees and clicks. Emails sent by the school district yielded the greatest number of clicks, which was influenced by message content and format. A community-academic partnership (CAP) led to the dissemination of evidence-based online parenting resources to a large population and led to lessons learned that could inform future research involving CAPs.


Assuntos
COVID-19 , Poder Familiar , Humanos , Pandemias , Pais , Instituições Acadêmicas
10.
J Community Psychol ; 50(1): 541-552, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096626

RESUMO

This study examined the accessibility of community resources (e.g., welfare programs and afterschool programs) for underserved youth and families with mental health needs. Mental health professionals (n = 52) from a large community mental health and welfare agency serving predominantly low-income, Latinx families completed a semistructured interview that asked about the accessibility of community resources. Participant responses were coded using an inductive thematic analysis. Results showed that 71% of participants endorsed availability barriers (e.g., limited local programs), 37% endorsed logistical barriers (e.g., waitlists), 27% endorsed attitudinal barriers (e.g., stigmatized beliefs about help-seeking), and 23% endorsed knowledge barriers (e.g., lacking awareness about local programs). Professionals' perceived availability barriers were mostly consistent with the actual availability of community resources. Findings highlight the compounding challenges that underserved communities face and point to opportunities for promoting enhanced well-being and functioning for youth and families with mental health needs.


Assuntos
Recursos Comunitários , Serviços de Saúde Mental , Adolescente , Humanos , Saúde Mental , Pobreza , Pesquisa Qualitativa
11.
Adm Policy Ment Health ; 47(4): 641-647, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32170492

RESUMO

This study explored whether post-treatment symptom severity moderated the association between session attendance during an initial treatment episode and subsequent mental health service use. Data on attendance, symptom severity, and service use were gathered from an effectiveness trial testing a modular treatment for youth anxiety, depression, disruptive behavior, and traumatic stress. Multilevel logistic regression analyses showed a significant interaction between attendance and post-treatment symptom severity on subsequent service use, such that attendance significantly predicted subsequent service use when post-treatment symptom severity was in the normal range. Implications regarding the influence of treatment engagement on future help-seeking are discussed.


Assuntos
Transtornos Mentais/fisiopatologia , Transtornos Mentais/terapia , Serviços de Saúde Mental , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Criança , Bases de Dados Factuais , Feminino , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Pesquisa Qualitativa , Índice de Gravidade de Doença , Resultado do Tratamento
12.
Adm Policy Ment Health ; 47(3): 366-379, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31721005

RESUMO

This study explored mental health professionals' perceptions about barriers and facilitators to engaging underserved populations. Responses were coded using an iterative thematic analysis based on grounded theory. Results revealed that many professionals endorsed barriers to engaging ethnic minorities and families receiving social services. Client-provider racial and linguistic matching, therapy processes and procedures (e.g., nonjudgmental stance), and implementation supports (e.g., supervision) were commonly nominated as engagement facilitators. Many professionals felt that an organizational culture focused on productivity is detrimental to client engagement. Findings shed light on professionals' perceived barriers to delivering high-quality care to underserved communities and illuminate potential engagement strategies.


Assuntos
Atitude do Pessoal de Saúde , Serviços Comunitários de Saúde Mental , Pessoal de Saúde/psicologia , Área Carente de Assistência Médica , Populações Vulneráveis , Adulto , Feminino , Disparidades nos Níveis de Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
13.
Adm Policy Ment Health ; 47(3): 344-356, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31728777

RESUMO

Use of evidence to inform clinical decisions has been shown to improve the quality and effectiveness of services. This study piloted an observational coding system for understanding providers and supervisors' use of evidence in their clinical decision-making. The Action Cycle and Use of Evidence Behavioral Observation Coding System (ACE-BOCS) is based on Graham et al. (Contin Educ Health Prof 26:13-24, 2006) conceptual framework for knowledge management, which articulates a sequence relevant to integrating evidence into decisions and actions, including identifying and selecting a problem and choosing, planning, and rehearsing a solution or action. Using the ACE-BOCS, two coders rated the extensiveness with which evidence was used to inform decisions made in clinical supervision sessions. In these clinical supervision sessions, supervisor-provider dyads discussed cases (N = 30; age range 8-19 years; 80% Latino/a or Hispanic ethnicity) that were identified as potentially being at risk for low treatment engagement in school mental health services. Results indicated that the ACE-BOCS can reliably and validly measure use of evidence and distinguish between strategic and indiscriminate use of evidence. The ACE-BOCS has value and utility for studying use of evidence, as it incorporates multiple actions related to service delivery and has the potential to be adapted for other aspects of mental healthcare decision-making beyond clinical supervision, as well as decision making within fields outside of mental health.


Assuntos
Tomada de Decisões , Medicina Baseada em Evidências , Serviços de Saúde Mental , Adulto , Feminino , Humanos , Masculino , Projetos Piloto , Melhoria de Qualidade , Qualidade da Assistência à Saúde/normas
14.
J Sch Psychol ; 76: 78-88, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31759471

RESUMO

Treatment engagement is a significant challenge in school mental health services. Despite a growing evidence base on effective interventions for treatment engagement, attempts to address these challenges rarely leverage the available relevant research. To close this gap, this pilot study examined the feasibility, acceptability, and initial implementation outcomes of a coordinated knowledge system (CKS) designed to support the efforts of school mental health (SMH) professionals to address treatment engagement challenges. A sample of four supervisors and their supervisees (n = 17) with master's of social work degrees serving youth within an urban SMH program were randomly assigned to either (a) a CKS condition that offered a unified set of resources to structure decisions about treatment engagement or (b) a survey plus practice guidelines (SPG) condition, in which resources were provided without an explicit model for their coordinated use. Feasibility was assessed quantitatively, acceptability was assessed quantitatively and qualitatively, and initial implementation outcomes were evaluated using a behavioral observation coding system. Results provided strong support for the feasibility and acceptability of the study design, instrumentation, and interventions. It appears that the CKS can be feasibly implemented with good acceptability. Patterns of initial implementation strongly suggested that, relative to the SPG, the CKS supports identification of engagement problems as well as intervention selection and planning. Findings also identified modifications to study procedures that would be necessary in a future study. A larger trial using similar methodology and instrumentation could yield important findings about the effectiveness of the CKS in clinical practice and could articulate the mechanisms by which it operates.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , Serviços de Saúde Mental Escolar , Adolescente , Adulto , Atitude do Pessoal de Saúde , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Projetos Piloto , Guias de Prática Clínica como Assunto
15.
Behav Ther ; 50(1): 225-240, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30661562

RESUMO

Cognitive behavioral therapies (CBT) for youth with anxiety, traumatic stress, and depression have demonstrated strong effects in individual studies and meta-analyses. Relatively more attention has been given to posttreatment effects, though, and assessment of follow-up effects has been limited at the meta-analytic level. The current meta-analysis aimed to (a) examine the effects of youth CBT at posttreatment, 1-month, 3-month, 6-month, 1-year, and long-term (2+ years) follow-up as well as (b) identify research-related variables (e.g., measure respondent type) that relate to effects. Using a random effects model across 110 child and adolescent CBT groups, within-group effect sizes were large at posttreatment (g = 1.24) and from 1-month through long-term follow-up (g = 1.23-1.82), and effect sizes did not significantly differ by treatment target (i.e., anxiety, traumatic stress, depression). However, availability of outcome data for effect sizes diminished across later follow-up assessments. Moreover, effect sizes were significantly associated with outcome respondent type across assessment timing, with outcome measures from caregiver and youth respondents associated with smaller effect sizes (B = -0.97, p < 0.001) relative to outcome measures that were evaluator-reported. Results provide initial support for the durability of treatment effects for youth CBTs and highlight the importance of some confounding variables. Implications for improving treatment research standards and prioritizing assessment of long-term follow-up assessment are discussed.


Assuntos
Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Transtornos de Estresse Pós-Traumáticos/terapia , Adolescente , Ansiedade/diagnóstico , Ansiedade/psicologia , Criança , Depressão/diagnóstico , Depressão/psicologia , Feminino , Seguimentos , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Fatores de Tempo , Resultado do Tratamento
16.
J Clin Child Adolesc Psychol ; 48(sup1): S202-S214, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-28318325

RESUMO

Emergent life events (ELEs)-unexpected stressors disclosed in psychotherapy that have a significant negative impact on the client-commonly occur in community populations of youth and are associated with decreased provider adherence to evidence-based treatment (EBT) in session. The present study extends previous research by examining longer term associations of ELEs with (a) provider adherence to planned EBT practices in subsequent sessions and (b) clinical progress. Data were drawn from the modular EBT condition (MATCH) of the Child STEPs California trial conducted with primarily Latino youth, ages 5-15, who were 54% male (Chorpita et al., 2017). Study 1 utilized data from 57 MATCH participants who reported at least one ELE during treatment. Provider adherence was measured by identifying whether planned practices were covered in either the session in which the ELE was reported or the following session using the MATCH Consultation Record. In Study 2, clinical progress for 78 MATCH participants was assessed using weekly youth- and caregiver-ratings of symptomatology (Brief Problem Checklist) and functioning (Top Problems Assessment). Study 1 revealed that ELEs were associated with reduced adherence to planned practices for at least two sessions. Study 2 demonstrated that each disruptive ELE (i.e., an ELE for which no EBT content was covered) was associated with a 14%-20% slower rate of clinical improvement, with greater declines for functioning and externalizing symptoms. Findings suggest that ELEs can be a major barrier to the effectiveness of an EBT and require further research in order to be addressed effectively.


Assuntos
Prática Clínica Baseada em Evidências/métodos , Acontecimentos que Mudam a Vida , Psicoterapia/métodos , Criança , Pré-Escolar , Feminino , Humanos , Masculino
17.
J Clin Child Adolesc Psychol ; 48(sup1): S79-S89, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-27704985

RESUMO

Codifying a complex treatment intervention into a manual necessarily involves simplifying procedures, possibly resulting in developer and expert adaptations that align with but are not fully consistent with the manualized content. This study evaluated the integrity of an evidence-based treatment to two information sources (i.e., an expert consultant and the treatment manual) within youth community mental health settings. Consultant recommendations were compared with manual-prescribed therapy procedures, which identified instances of agreement between the sources as well as consultant adaptations. To determine clinicians' integrity to each source, clinician-reported therapy procedures were compared with consultant recommendations and manual prescriptions. Participants consisted of 30 clinicians, five consultants, and 78 youths (53% male; M age = 9.73 years, SD = 2.84; 81% Latino). Findings indicated that consultants generally recommended content from the manual but also made frequent adaptations that involved changing the sequence or problem focus of practices and adding additional content. Clinicians followed both information sources in a majority of their sessions when these sources agreed but were more likely to follow only one or neither source when they disagreed. Findings suggest that consultants often make adaptations to the manual and that clinicians are more likely to employ recommendations from the manual and/or consultant when the information sources are in agreement. Although it is as yet unclear whether consultant recommendations are effective when they differ from the prescriptions of the manual, results from this study indicate that information sources that supplement treatment manuals may benefit clinical decision making.


Assuntos
Consultores/psicologia , Psicoterapia/métodos , Criança , Feminino , Humanos , Masculino
18.
Adm Policy Ment Health ; 45(4): 649-660, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29445993

RESUMO

This study examined patterns of evidence-based treatment (EBT) delivery following a county-wide EBT reform initiative. Data were gathered from 60 youth and their 21 providers, who were instructed to deliver therapy as they normally would under the EBT initiative. Results showed limited applicability of county-supported EBTs to this service sample, and that most youth did not receive traditional delivery of EBTs. Findings suggest that it may be unrealistic to expect providers to deliver EBTs with fidelity with all clients, and that EBT implementation may be best thought of as a strategy for improving mental health services rather than a goal.


Assuntos
Prática Clínica Baseada em Evidências/normas , Política de Saúde , Transtornos Mentais/terapia , Serviços de Saúde Mental/normas , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Ciência da Implementação , Los Angeles , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
J Clin Child Adolesc Psychol ; 47(5): 796-807, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-27610741

RESUMO

The goal of this study is to explore providers' patterns of implementation by investigating how community mental health providers selected therapy practice modules from a flexible, modular evidence-based treatment working with youths with comorbid mental health problems. Data were obtained from 57 youths, 5-15 years old, presenting with anxiety, depressive, and/or conduct problems and their 27 providers during their participation in an effectiveness trial involving a modular evidence-based treatment. Although all youths evidenced clinically elevated symptomatology in at least two problem areas, providers targeted youths' comorbid problems with only about half of their study cases. Practice modules indicated for youths' comorbid problems were typically used less frequently and with less depth relative to practice modules indicated for youths' principal clinical problem and were often transdiagnostic in nature (i.e., designed to target more than one problem area). To determine whether providers' decisions to target youths' comorbid problems were systematic, multilevel, logistic regression analyses were conducted and revealed that youths' pretreatment characteristics and time in therapy influenced providers' patterns of module selection. Providers tend to use, but not exploit, the flexibility allowed by modular EBTs and to focus treatment on youths' principal presenting problem. In addition, providers appear to make these practice choices in a systematic and rational manner, and whether and which choices are associated with improved outcomes is an important area of future study.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Pessoal de Saúde , Saúde Mental , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/terapia , Adolescente , Adulto , Idoso , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Criança , Pré-Escolar , Serviços Comunitários de Saúde Mental/tendências , Comorbidade , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Feminino , Pessoal de Saúde/tendências , Humanos , Masculino , Saúde Mental/tendências , Pessoa de Meia-Idade , Transtornos do Neurodesenvolvimento/psicologia , Adulto Jovem
20.
Behav Res Ther ; 90: 147-158, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28061375

RESUMO

This review included 136 published randomized controlled trials (RCTs) of youth cognitive behavioral therapy (CBT) treatments. We aimed to test the premise that evidence-based youth treatments can be better differentiated from each other by applying more nuanced standards of evidence. Accordingly, we applied three standards to this article sample to determine how many treatments produced significant results: (a) on multiple target symptom measures, (b) at follow-up, and/or (c) against an active comparison group. We identified how many trials met standards individually and in combination. Although 87 of the 136 articles produced at least one significant treatment result at post-assessment, the subsets of "passing" articles were smaller and varied for any one of our three standards, with only 11 articles (8%) meeting all three standards simultaneously. Implications are discussed regarding the definition of "evidence-based," the need for multi-parameter filtering in treatment selection and clinical decision making, and future directions for research. We ultimately argue the value in assessing youth treatments for different types of evidence, which is better achieved through dynamic sets of standards, rather than a single approach to assessing general strength of evidence.


Assuntos
Terapia Cognitivo-Comportamental , Transtornos Mentais/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Fatores Etários , Humanos , Resultado do Tratamento
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