Beidas, Rinad S
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Publication Handoffs and Transitions in Critical Care (HATRICC): Protocol for a Mixed Methods Study of Operating Room to Intensive Care Unit Handoffs(2014-01-01) Lane-Fall, Meghan B; Beidas, Rinad S; Pascual, Jose L; Collard, Meredith L; Peifer, Hannah G; Barry, Mark E; Gutsche, Jacob; Halpern, Scott D; Fleisher, Lee A; Barg, Frances K; Chavez, Tyler JBackground: Operating room to intensive care unit handoffs are high-risk events for critically ill patients. Studies in selected patient populations show that standardizing operating room to intensive care unit handoffs improves information exchange and decreases errors. To adapt these findings to mixed surgical populations, we propose to study the implementation of a standardized operating room to intensive care unit handoff process in two intensive care units currently without an existing standard process. Methods/Design: The Handoffs and Transitions in Critical Care (HATRICC) study is a hybrid effectiveness- implementation trial of operating room to intensive care unit handoffs. We will use mixed methods to conduct a needs assessment of the current handoff process, adapt published handoff processes, and implement a new standardized handoff process in two academic intensive care units. Needs assessment: We will use non-participant observation to observe the current handoff process. Focus groups, interviews, and surveys of clinicians will elicit participants’ impressions about the current process. Adaptation and implementation: We will adapt published standardized handoff processes using the needs assessment findings. We will use small group simulation to test the new process’ feasibility. After simulation, we will incorporate the new handoff process into the clinical work of all providers in the study units. Evaluation: Using the same methods employed in the needs assessment phase, we will evaluate use of the new handoff process. Data analysis: The primary effectiveness outcome is the number of information omissions per handoff episode as compared to the pre-intervention period. Additional intervention outcomes include patient intensive care unit length of stay and intensive care unit mortality. The primary implementation outcome is acceptability of the new process. Additional implementation outcomes include feasibility, fidelity and sustainability. Discussion: The HATRICC study will examine the effectiveness and implementation of a standardized operating room to intensive care unit handoff process. Findings from this study have the potential to improve healthcare communication and outcomes for critically ill patients. Trial registration: ClinicalTrials.gov identifier: NCT02267174. Date of registration October 16, 2014.Publication Predictors of Community Therapists' Use of Therapy Techniques in a Large Public Mental Health System(2015-04-01) Beidas, Rinad S; Marcus, Steven C; Evans, Arthur C; Hurford, Matthew O; Hadley, Trevor; Barg, Frances K; Aarons, Gregory; Hoagwood, Kimberly; Schoenwald, Sonja; Mandell, David S; Walsh, Lucia M; Adams, Danielle RImportance Few studies have examined the effects of individual and organizational characteristics on the use of evidence-based practices in mental health care. Improved understanding of these factors could guide future implementation efforts to ensure effective adoption, implementation, and sustainment of evidence-based practices. Objective To estimate the relative contribution of individual and organizational factors on therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques within the context of a large-scale effort to increase use of evidence-based practices in an urban public mental health system serving youth and families. Design, Setting, and Participants In this observational, cross-sectional study of 23 organizations, data were collected from March 1 through July 25, 2013. We used purposive sampling to recruit the 29 largest child-serving agencies, which together serve approximately 80% of youth receiving publically funded mental health care. The final sample included 19 agencies with 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators. Main Outcomes and Measures Therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques, as measured by the Therapist Procedures Checklist–Family Revised. Results Individual factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 16%; family therapy techniques, 7%; and psychodynamic therapy techniques, 20%. Organizational factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 23%; family therapy techniques, 19%; and psychodynamic therapy techniques, 7%. Older therapists and therapists with more open attitudes were more likely to endorse use of cognitive-behavioral therapy techniques, as were those in organizations that had spent fewer years participating in evidence-based practice initiatives, had more resistant cultures, and had more functional climates. Women were more likely to endorse use of family therapy techniques, as were those in organizations employing more fee-for-service staff and with more stressful climates. Therapists with more divergent attitudes and less knowledge about evidence-based practices were more likely to use psychodynamic therapy techniques. Conclusions and Relevance This study suggests that individual and organizational factors are important in explaining therapist behavior and use of evidence-based practices, but the relative importance varies by therapeutic technique.Publication Non-Participants in Policy Efforts to Promote Evidence-Based Practices in a Large Behavioral Health System(2017-01-01) Stewart, Rebecca E; Mandell, David S; Nangia, Gayari; Evans, Arthur C; Adams, Danielle R; Hadley, Trevor; Beidas, Rinad S; Shaffer, Lauren; Rubin, Ronnie M; Weaver, Shawna LBackground: System-wide training initiatives to support and implement evidence-based practices (EBPs) in behavioral health systems have become increasingly widespread. Understanding more about organizations who do not participate in EBP training initiatives is a critical piece of the dissemination and implementation puzzle if we endeavor to increase access in community settings. Methods: We conducted 30 1-h semi-structured interviews with leaders in non-participating agencies who did not formally participate in system-wide training initiatives to implement EBPs in the City of Philadelphia, with the goal to understand why they did not participate. Results: We found that despite not participating in training initiatives, most agencies were adopting (and self-financing) some EBP implementation. Leadership from agencies that were implementing EBPs reported relying on previously trained staff to implement EBPs and acknowledged a lack of emphasis on fidelity. Most leaders at agencies not adopting EBPs did not have a clear understanding of what EBP is. Those familiar with EBPs in agencies not adopting EBPs reported philosophical objections to EBPs. When asked about quality assurance and treatment selection, leaders reported being guided by system audits. Conclusions: While it is highly encouraging that many agencies are adopting EBPs on their own, significant questions about fidelity and implementation success more broadly remain.Publication Cognitive-Behavioral Treatment of Anxious Youth with Comorbid School Refusal: Clinical Presentation and Treatment Response(2010-01-01) Beidas, Rinad S; Crawley, Sarah A; Mychailyszyn, Matthew P; Comer, Jonathan S; Kendall, Phillip CThe present study investigated the effectiveness of cognitive-behavioral therapy in youth (N = 27) diagnosed with a principal anxiety disorder and school refusal (SR; denial to attend school or difficulty remaining in school). Scant research examines the effectiveness of cognitive-behavioral therapy for treatment-seeking youth with a primary anxiety disorder and comorbid SR. Effects for youth who completed treatment (N = 12) ranged from d = .61 to 2.27 based on youth- and parent-reported anxiety and depressive symptoms, as well as independently rated global functioning. A discussion of treatment drop-out, a case illustration, and treatment recommendations are provided.Publication Research Review(2010-01-01) Beidas, Rinad S; Lyon, Aaron RGiven the commonly-cited "research-practice gaps" and nascent status of the dissemination and implementation (DI) field as it relates to psychological science, a multidisciplinary synthesis of the literature relating to DI efforts is an important addition. This is particularly true given that one prominent criticism of the DI field is that efforts to disseminate and implement evidence-based practice (EBP) lack their own empirical foundation.Publication A Randomized Trial to Identify Accurate and Cost-Effective Fidelity Measurement Methods for Cognitive-Behavioral Therapy: Project FACTS Study Protocol(2016-01-01) Beidas, Rinad S; Fishman, Jessica; Mandell, David S; Shea, Judy A; Maclean, Johanna C; Dorsey, Shannon; Schoenwald, Sonja; Lieberman, Adina E; Becker-Haimes, Emily M; Marcus, Steven C; McLeod, Bryce D; French, Michael T; Hogue, Aaron; Adams, Danielle RBackground: This randomized trial will compare three methods of assessing fidelity to cognitive-behavioral therapy (CBT) for youth to identify the most accurate and cost-effective method. The three methods include self-report (i.e., therapist completes a self-report measure on the CBT interventions used in session while circumventing some of the typical barriers to self-report), chart-stimulated recall (i.e., therapist reports on the CBT interventions used in session via an interview with a trained rater, and with the chart to assist him/her) and behavioral rehearsal (i.e., therapist demonstrates the CBT interventions used in session via a role-play with a trained rater). Direct observation will be used as the gold-standard comparison for each of the three methods. Methods/design: This trial will recruit 135 therapists in approximately 12 community agencies in the City of Philadelphia. Therapists will be randomized to one of the three conditions. Each therapist will provide data from three unique sessions, for a total of 405 sessions. All sessions will be audio-recorded and coded using the Therapy Process Observational Coding System for Child Psychotherapy-Revised Strategies scale. This will enable comparison of each measurement approach to direct observation of therapist session behavior to determine which most accurately assesses fidelity. Cost data associated with each method will be gathered. To gather stakeholder perspectives of each measurement method, we will use purposive sampling to recruit 12 therapists from each condition (total of 36 therapists) and 12 supervisors to participate in semi-structured qualitative interviews. Discussion: Results will provide needed information on how to accurately and cost-effectively measure therapist fidelity to CBT for youth, as well as important information about stakeholder perspectives with regard to each measurement method. Findings will inform fidelity measurement practices in future implementation studies as well as in clinical practice. Trial registration: NCT02820623, June 3rd, 2016.Publication A Mixed Methods Study of Individual and Organizational Factors that Affect Implementation of Interventions for Children with Autism in Public Schools(2016-01-01) Beidas, Rinad S; Marcus, Steven C; Locke, Jill; Cannuscio, Carolyn C; Barg, Frances K; Stahmer, Aubyn; Aarons, Gregory; Mandell, David S; Lyon, Aaron R; Dorsey, ShannonBackground: The significant lifelong impairments associated with autism spectrum disorder (ASD), combined with the growing number of children diagnosed with ASD, have created urgency in improving school-based quality of care. Although many interventions have shown efficacy in university-based research, few have been effectively implemented and sustained in schools, the primary setting in which children with ASD receive services. Individual- and organizational-level factors have been shown to predict the implementation of evidence-based interventions (EBIs) for the prevention and treatment of other mental disorders in schools, and may be potential targets for implementation strategies in the successful use of autism EBIs in schools. The purpose of this study is to examine the individual- and organizational-level factors associated with the implementation of EBIs for children with ASD in public schools. Methods: We will apply the Domitrovich and colleagues (2008) framework that examines the influence of contextual factors (i.e., individual- and organizational-level factors) on intervention implementation in schools. We utilize mixed methods to quantitatively test whether the factors identified in the Domitrovich and colleagues (2008) framework are associated with the implementation of autism EBIs, and use qualitative methods to provide a more comprehensive understanding of the factors associated with successful implementation and sustainment of these interventions with the goal of tailoring implementation strategies. Discussion: The results of this study will provide an in-depth understanding of individual- and organizational-level factors that influence the successful implementation of EBIs for children with ASD in public schools. These data will inform potential implementation targets and tailoring of strategies that will help schools overcome barriers to implementation and ultimately improve the services and outcomes for children with ASD.Publication Cognitive-Behavioral Therapy with Youth(2010-01-01) Crawley, Sarah A; Podell, Jennifer L; Beidas, Rinad S; Braswell, Lauren; Kendall, Phillip CCognitive-behavioral therapies (CBTs) with children and adolescents use enactive, performance-based procedures, as well as cognitive interventions to produce changes in thinking, feeling, and behavior. Various forms of CBT have a common goal to help the child develop a constructive worldview and a problem-solving attitude. The problem-solving orientation can also be referred to as a "coping template." Through the provision of carefully planned experiences, CBT helps the child and family build an adaptive, problem-solving perspective.Publication Sustaining Clinician Penetration, Attitudes and Knowledge in Cognitive-Therapy for Youth Anxiety(2014-01-01) Edmunds, Julie M; Read, Kendra L; Ringle, Vanesa A; Brodman, Douglas M; Kendall, Phillip C; Beidas, Rinad SBackground: Questions remain regarding the sustainment of evidence-based practices following implementation. The present study examined the sustainment of community clinicians’ implementation (i.e., penetration) of cognitive-behavioral therapy, attitudes toward evidence-based practices, and knowledge of cognitive-behavioral therapy for youth anxiety two years following training and consultation in cognitive-behavioral therapy for youth anxiety. Methods: Of the original 115 participants, 50 individuals (43%) participated in the two-year follow-up. A t- test examined sustainment in penetration over time. Hierarchical linear modeling examined sustainment in knowledge and attitudes over time. Time spent in consultation sessions was examined as a potential moderator of the change in knowledge and attitudes. Results: Findings indicated sustained self-reported penetration of cognitive-behavioral therapy for anxious youth, with low fidelity to some key CBT components (i.e., exposure tasks). Follow-up knowledge was higher than at baseline but lower than it had been immediately following the consultation phase of the study. Belief in the utility of evidence-based practices was sustained. Willingness to implement an evidence-based practice if required to do so, appeal of evidence-based practices, and openness toward evidence-based practices were not sustained. Participation in consultation positively moderated changes in knowledge and some attitudes. Conclusions: Sustainment varied depending on the outcome examined. Generally, greater participation in consultation predicted greater sustainment. Implications for future training include higher dosages of consultation.Publication Individual Differences in the Formation of False Memories: Is Suggestibility a Predictive Factor?(2003-01-01) Beidas, Rinad SIndividual differences in the formation of false memories using suggestibility as a predictive factor were investigated. Undergraduate males and females were administered two false memory paradigms: the Deese-Roedinger-McDermott (DRM) (1995) word recognition task and the Kassin & Kiechel (KK) ALT key task (1996). Subsequently, participants were administered the Gudjonsson Suggestibility Scale (GSS) 2 to determine their suggestibility scores. As predicted, higher suggestibility scores were correlated with forming a false memory in the Kassin & Kiechel task. However, suggestibility was not correlated with the DRM task. These results provide evidence that suggestibility is a predictive factor for one false memory paradigm but not the other, indicating that perhaps different cognitive mechanisms underlie the two.