Department of Psychiatry
Now showing 1 - 10 of 20
PublicationStudy Protocol: Implementation of a Computer-Assisted Intervention for Autism in Schools: A Hybrid Type II Cluster Randomized Effectiveness-Implementation Trial(2016-01-01) Pellecchia, Melanie; Beidas, Rinad S; Marcus, Steven C; Fishman, Jessica; Kimberly, John R.; Cannuscio, Carolyn C; Reisinger, Erica M; Rump, Keiran; Mandell, David SBackground: The number of children diagnosed with autism has rapidly outpaced the capacities of many public school systems to serve them, especially under-resourced, urban school districts. The intensive nature of evidence-based autism interventions, which rely heavily on one-to-one delivery, has caused schools to turn to computer-assisted interventions (CAI). There is little evidence regarding the feasibility, effectiveness, and implementation of CAI in public schools. While CAI has the potential to increase instructional time for students with autism, it may also result in unintended consequences such as reduction in the amount of interpersonal (as opposed to computerized) instruction students receive. The purpose of this study is to test the effectiveness of one such CAI—TeachTown—its implementation, and its effects on teachers’ use of other evidence-based practices. Methods:This study protocol describes a type II hybrid cluster randomized effectiveness-implementation trial. We will train and coach 70 teachers in autism support classrooms in one large school district in the use of evidence-based practices for students with autism. Half of the teachers then will be randomly selected to receive training and access to TeachTown: Basics, a CAI for students with autism, for the students in their classrooms. The study examines: (1) the effectiveness of TeachTown for students with autism; (2) the extent to which teachers implement TeachTown the way it was designed (i.e., fidelity); and (3) whether its uptake increases or reduces the use of other evidence-based practices. Discussion: This study will examine the implementation of new technology for children with ASD in public schools and will be the first to measure the effectiveness of CAI. As importantly, the study will investigate whether adding a new technology on top of existing practices increases or decreases their use. This study presents a unique method to studying both the implementation and exnovation of evidence-based practices for children with autism in school settings. Trial registration: NCT02695693. Retrospectively registered on July 8, 2016. PublicationCognitive-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. PublicationHandoffs 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; Chavez, Tyler J; Barry, Mark E; Gutsche, Jacob; Halpern, Scott D; Fleisher, Lee A; Barg, Frances KBackground: 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. PublicationPredictors of Community Therapists' Use of Therapy Techniques in a Large Public Mental Health System(2015-04-01) Beidas, Rinad S; Marcus, Steven C; Aarons, Gregory; Hoagwood, Kimberly; Schoenwald, Sonja; Evans, Arthur C; Hurford, Matthew O; Hadley, Trevor; Barg, Frances K; Walsh, Lucia M; Adams, Danielle R; Mandell, David SImportance 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. PublicationA Complementary Marriage of Perspectives: Understanding Organizational Social Context Using Mixed Methods(2014-01-01) Beidas, Rinad S; Wolk, Courtney L B; Walsh, Lucia M; Evans, Arthur C; Hurford, Matthew O; Barg, Frances KBackground: Organizational factors impact the delivery of mental health services in community settings. Mixed-methods analytic approaches have been recommended, though little research within implementation science has explicitly compared inductive and deductive perspectives to understand their relative value in understanding the same constructs. The purpose of our study is to use two different paradigmatic approaches to deepen our understanding of organizational social context. We accomplish this by using a mixed-methods approach in an investigation of organizational social context in community mental health clinics. Methods: Nineteen agencies, representing 23 sites, participated. Enrolled participants included 130 therapists, 36 supervisors, and 22 executive administrators. Quantitative data was obtained via the Organizational Social Context (OSC) measure. Qualitative data, comprised of direct observation with spot sampling generated from agency visits, was coded using content analysis and grounded theory. The present study examined elements of organizational social context that would have been missed if only quantitative data had been obtained and utilized mixed methods to investigate if stratifying observations based on quantitative ratings from the OSC resulted in the emergence of differential themes. Results: Four of the six OSC constructs were commonly observed in field observations (i.e., proficiency, rigidity, functionality, stress), while the remaining two constructs were not frequently observed (i.e., resistance, engagement). Constructs emerged related to organizational social context that may have been missed if only quantitative measurement was employed, including those around the physical environment, commentary about evidence-based practice initiatives, leadership, cultural diversity, distrust, and affect. Stratifying agencies by “best,” “average,” and “worst” organizational social context impacted interpretation for three constructs (affect, stress, and leadership). Conclusions: Results support the additive value of integrating inductive and deductive perspectives in implementation science research. This synthesis of approaches facilitated a more comprehensive understanding and interpretation of the findings than would have been possible if either methodology had been employed in isolation. PublicationContextual Influences and Strategies for Dissemination and Implementation in Mental Health(2015-01-01) Wolk, Courtney L B; Powell, Byron J; Beidas, Rinad SImplementation science has emerged to bridge the gap between research and practice. A number of conceptual frameworks have been developed to advance implementation research and illuminate the contextual influences that can facilitate or impede the implementation of evidence-based practices. Contextual factors that may be important in the dissemination and implementation of evidence-based practice may occur at the system-, organizational-, and provider-levels. System-level barriers may include external policies, incentives, and peer pressure. Organizational-level factors that are important in implementation include organizational culture and climate and implementation climate. At the individual provider-level, barriers may occur around provider attitudes, knowledge, and self-efficacy. Finally, additional barriers such as client-level that can be used to overcome contextual barriers when attempting to implement evidence-based practices into new settings. Several exemplar implementation strategies are discussed, including the Availability, Responsiveness, and Continuity intervention, Community Development Team model, and Interagency Collaborative Team Model. PublicationSustaining 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. PublicationRelationships between Clinician-Level Attributes and Fidelity-Consistent and Fidelity-Inconsistent Modifications to an Evidence-Based Psychotherapy(2015-01-01) Stirman, Shannon W; Gutner, Cassidy A; Crits-Christoph, Paul F; Edmunds, Julie; Evans, Arthur C; Beidas, Rinad SBackground: Clinicians often modify evidence-based psychotherapies (EBPs) when delivering them in routine care settings. There has been little study of factors associated with or implications of modifications to EBP protocols. This paper differentiates between fidelity-consistent and fidelity-inconsistent modifications and it examines the potential influence of two clinician characteristics, training outcomes, and attitudes toward EBPs on fidelity-consistent and fidelity-inconsistent modifications of cognitive behavioral therapy in a sample of clinicians who had been trained to deliver these treatments for children or adults. Methods: Survey and coded interview data collected 2 years after completion of training programs in cognitive behavioral therapy were used to examine associations between successful or unsuccessful completion of training, clinician attitudes, and modifications. Modifications endorsed by clinicians were categorized as fidelity-consistent or fidelity-inconsistent and entered as outcomes into separate regression models, with training success and attitudes entered as independent variables. Results: Successful completion of a training program was associated with subsequent fidelity-inconsistent modifications but not fidelity-consistent modifications. Therapists who reported greater openness to using EBPs prior to training reported more fidelity-consistent modifications at follow-up, and those who reported greater willingness to adopt EBPs if they found them appealing were more likely to make fidelity-inconsistent modifications. Conclusions: Implications of these findings for training, implementation, EBP sustainment, and future studies are discussed. Research on contextual and protocol-related factors that may impact decisions to modify EBPs will be an important future direction of study to complement to this research. PublicationNon-Participants in Policy Efforts to Promote Evidence-Based Practices in a Large Behavioral Health System(2017-01-01) Stewart, Rebecca E; Adams, Danielle R; Mandell, David S; Nangia, Gayari; Shaffer, Lauren; Evans, Arthur C; Rubin, Ronnie M; Weaver, Shawna L; Hadley, Trevor; Beidas, Rinad SBackground: 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. PublicationThe Promise of Evidence-Based Practices in Child and Adolescent Mental Health(2014-01-01) Kendall, Phillip C; Beidas, Rinad SThe push for evidence-based practices has dominated the mental health and health care arenas for more than a decade. Conversations among professionals who provide mental health services for youth have included both support and opposition to this position. On the one hand, there is a plethora of discourse indicating widespread support for the need to provide the best available services for youth in need, delivered through the provision of evidence-based practices. On the other hand, there are also opponents to this viewpoint, primarily arguing that evidence-based practices developed in research settings may not fit the context of community providers. A gap already existed between research and practice, and the push for evidence-based practices has further widened the rift between divisions in the mental health field.