Department of Psychiatry




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Now showing 1 - 10 of 20
  • 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 C
    The 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
    Contextual Influences and Strategies for Dissemination and Implementation in Mental Health
    (2015-01-01) Wolk, Courtney L B; Powell, Byron J; Beidas, Rinad S
    Implementation 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.
  • Publication
    Research Review
    (2010-01-01) Beidas, Rinad S; Lyon, Aaron R
    Given 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
    Training as Usual: Can Therapist Behavior Change After Reading a Manual and Attending a Brief Workship on Cognitive Behavioral Therapy for Youth Anxiety?
    (2009-06-01) Beidas, Rinad S; Barmish, Andrea J; Kendall, Phillip C
    There exists an ongoing movement to transport empirically supported treatments (ESTs), developed and evaluated in research clinics, to service providing clinics. ESTs refer to psychological interventions that have been evaluated scientifically (e.g., randomized controlled trial; RCT) and satisfy the Chambless and Hollon (1998) criteria (Kendall & Beidas, 2007). Dissemination research encompasses both dissemination (purposeful distribution of relevant information and materials to clinicians) and implementation (adoption and integration of EST in clinical practice) of ESTs (Lomas, 1993). However, for a variety of reasons (Addis & Krasnow, 2000; Riley, Schuman, Forman-Hoffman, Mihm, Applegate, & Asif, 2007), resistance to dissemination and implementation exists. We focus on training therapists in ESTs (i.e., dissemination). Thus, a key question arises: Do current training efforts practice in the community (i.e., reading a manual and attending a brief training workshop) effectively influence therapist behavior in those who are naïve to fundamental principles of an EST?
  • Publication
    Policy to Implementation: Evidence-Based Practice in Community Mental Health — Study Protocol
    (2013-01-01) Beidas, Rinad S; Barg, Frances K; Evans, Arthur C; Hadley, Trevor; Marcus, Steven C; Aarons, Gregory; Mandell, David S; Hoagwood, Kimberly; Schoenwald, Sonia; Walsh, Lucia
    Background: Evidence-based treatments (EBTs) are not widely available in community mental health settings. In response to the call for implementation of evidence-based treatments in the United States, states and counties have mandated behavioral health reform through policies and other initiatives. Evaluations of the impact of these policies on implementation are rare. A systems transformation about to occur in Philadelphia, Pennsylvania, offers an important opportunity to prospectively study implementation in response to a policy mandate. Methods/design: Using a prospective sequential mixed-methods design, with observations at multiple points in time, we will investigate the responses of staff from 30 community mental health clinics to a policy from the Department of Behavioral Health encouraging and incentivizing providers to implement evidence-based treatments to treat youth with mental health problems. Study participants will be 30 executive directors, 30 clinical directors, and 240 therapists. Data will be collected prior to the policy implementation, and then at two and four years following policy implementation. Quantitative data will include measures of intervention implementation and potential moderators of implementation (i.e., organizational- and leader-level variables) and will be collected from executive directors, clinical directors, and therapists. Measures include self-reported therapist fidelity to evidence-based treatment techniques as measured by the Organizational Social Context Measurement System and the Implementation Climate Assessment, leader variables as measured by the Multifactor Leadership Questionnaire, attitudes towards EDTs as measured by the Evidence-Based Practice Attitude Scale, and knowledge of EBTs as measured by the knowledge of Evidence-Based Services Questionnaire. Qualitative data will include semi-structured interviews with a subset of the sample to assess the implementation experience of high-, average-, and low-performing agencies. Mixed methods will be integrated through comparing and contrasting results from the two methods for each of the primary hypotheses in this study. Discussion: Findings from the proposed research will inform both future policy mandates around implementation and the support required for the success of these policies, with the ultimate goal of improving the quality of treatment provided to youth in the public sector.
  • Publication
    Cognitive-Behavioral Treatment for Child and Adolescent Anxiety: The Coping Cat Program
    (2008-01-01) Beidas, Rinad S; Podell, Jennifer L; Kendall, Phillip C
    Anxiety disorders are common psychological disorders experienced by youth (Warren & messer, 1999), with reported rates of 10-20% in the general population and primary care settings (Chavira, Stein, Bailey, & Stein, 2004; Costello, Mustillo, Keeler, & Angold, 2004). Anxiety disorders in youth include generalized anxiety disorder (GAD), social phobia (SP), separation anxiety disorder (SAD), specific phobias, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) (APA, 1994). In this chapter, we focus on treatment for the three youth anxiety disorders: GAD, SP, and SAD.
  • Publication
    Dissemination and Implementation Science: Research Models and Methods
    (2013-01-01) Beidas, Rinad S; Mehta, Tara G; Atkins, Marc; Solomon, Bonnie; Merz, Jenna
    Dissemination and implementation (DI) science has grown exponentially in the past decade. This chapter reviews and discusses the research methodology pertinent to empirical DI inquiry within mental health services research. This chapter (a) reviews models of DI science, (b) presents and discusses design, variables, and measures relevant to DI processes, and (c) offers recommendations for future research.
  • Publication
    The Promise of Evidence-Based Practices in Child and Adolescent Mental Health
    (2014-01-01) Kendall, Phillip C; Beidas, Rinad S
    The 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.
  • Publication
    Relationships between Clinician-Level Attributes and Fidelity-Consistent and Fidelity-Inconsistent Modifications to an Evidence-Based Psychotherapy
    (2015-01-01) Crits-Christoph, Paul F; Stirman, Shannon W; Gutner, Cassidy A; Evans, Arthur C; Beidas, Rinad S; Edmunds, Julie
    Background: 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.
  • Publication
    A Complementary Marriage of Perspectives: Understanding Organizational Social Context Using Mixed Methods
    (2014-01-01) Beidas, Rinad S; Wolk, Courtney L B; Evans, Arthur C; Hurford, Matthew O; Barg, Frances K; Walsh, Lucia M
    Background: 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.