Authors:Anne-Katharina Schiefele; Wolfgang Lutz; Michael Barkham; Julian Rubel; Jan Böhnke; Jaime Delgadillo; Mark Kopta; Dietmar Schulte; David Saxon; Stevan L. Nielsen; Michael J. Lambert Pages: 598 - 613 Abstract: Abstract This paper aims to provide researchers with practical information on sample sizes for accurate estimations of therapist effects (TEs). The investigations are based on an integrated sample of 48,648 patients treated by 1800 therapists. Multilevel modeling and resampling were used to realize varying sample size conditions to generate empirical estimates of TEs. Sample size tables, including varying sample size conditions, were constructed and study examples given. This study gives an insight into the potential size of the TE and provides researchers with a practical guide to aid the planning of future studies in this field. PubDate: 2017-09-01 DOI: 10.1007/s10488-016-0736-3 Issue No:Vol. 44, No. 5 (2017)
Authors:John Cologon; Robert D. Schweitzer; Robert King; Tobias Nolte Pages: 614 - 625 Abstract: Abstract This study investigated the relationship between two therapist attributes (reflective functioning and attachment style) and client outcome. Twenty-five therapists treated a total of 1001 clients. Therapists were assessed for reflective functioning and attachment style using the Adult Attachment Interview and the Experiences in Close Relationships Scale. Clinical outcome was measured using the Outcome Questionnaire (OQ-45). Data were analysed using hierarchical linear modelling. Results indicated that therapist reflective functioning predicted therapist effectiveness, whereas attachment style did not. However, there was evidence of an interaction between therapist attachment style and therapist reflective functioning. Secure attachment compensated somewhat for low reflective functioning and high reflective functioning compensated for insecure attachment. Possible implications for the selection of therapy training candidates and therapist training are discussed. PubDate: 2017-09-01 DOI: 10.1007/s10488-017-0790-5 Issue No:Vol. 44, No. 5 (2017)
Authors:Aaron Hogue; Sarah Dauber; Craig E. Henderson Pages: 626 - 641 Abstract: Abstract This study evaluated whether community therapists delivering family therapy for adolescent behavior problems in usual care achieved performance benchmarks established in controlled trials for treatment fidelity and outcomes, with particular focus on individual differences in therapist performance. The study contained N = 38 adolescents (50 % male; mean age 15 years) whose self-reported race/ethnicity was Hispanic (74 %), African American (11 %), multiracial (11 %), and other (4 %). Clients were treated by 13 therapists in one community mental health clinic that delivered family therapy as the routine standard of care. Therapists provided self-report data on adherence to core family therapy techniques; these scores were inflation-adjusted based on concordance with observer reports. Results showed that community therapists surpassed the fidelity benchmark for core family therapy techniques established by research therapists during a controlled trial. Regarding change in client functioning at 6-month follow-up, community therapists were equivalent to the benchmark for internalizing symptoms and superior for externalizing symptoms and delinquent acts. Community therapists also demonstrated a high degree of performance uniformity: Each one approximated the fidelity benchmark, and only two produced relatively weak outcomes on any of the client change indicators. Caveats for interpreting therapist performance data, given the small sample size, are described. Recommendations are made for developing therapist-report fidelity measures and utilizing statistical process control methods to diagnose therapist differences and enhance quality assurance procedures. PubDate: 2017-09-01 DOI: 10.1007/s10488-016-0769-7 Issue No:Vol. 44, No. 5 (2017)
Authors:Brian Shiner; Christine Leonard Westgate; Juliette M. Harik; Bradley V. Watts; Paula P. Schnurr Pages: 642 - 650 Abstract: Abstract Extant literature suggests that patient-therapist gender matching may be associated with psychotherapy retention. We examined this relationship in a national cohort of Veterans (n = 506,471) initiating psychotherapy for posttraumatic stress disorder (PTSD) using multivariate logistic regression models. Overall, women were retained in psychotherapy at higher rates than men. When patient and therapist factors as well as practice patterns are considered, gender match between female patients with PTSD and female therapists was not a positive predictor of psychotherapy retention. Contrary to our expectations, gender match between male patients with PTSD and male therapist was a negative predictor of psychotherapy retention. PubDate: 2017-09-01 DOI: 10.1007/s10488-016-0761-2 Issue No:Vol. 44, No. 5 (2017)
Authors:Fang-pei Chen Pages: 651 - 663 Abstract: Abstract The trademark of mental health clubhouses is that members and staff work side-by-side in partnership to enhance members’ autonomy, competency, and recovery. To explore the intricacies of this unique approach, the author conducted 53 in-depth interviews and 262 h of participant observation in 41 visits over a five-month period in a clubhouse. Findings indicated that staff members built the clubhouse as a “working community” by skillfully integrating three practice domains: social relationships, unit work, and individuals’ needs and pursuits. Distinctive skillsets helped to develop genuine relationships with members and facilitate community building, suggesting a model of generalist practice with specific intentionality. PubDate: 2017-09-01 DOI: 10.1007/s10488-016-0757-y Issue No:Vol. 44, No. 5 (2017)
Authors:Robert J. King; Jayne A. Orr; Brooke Poulsen; S. Giac Giacomantonio; Catherine Haden Pages: 664 - 680 Abstract: Abstract Understanding the role that therapists play in psychotherapy outcome, and the contribution to outcome made by individual therapist differences has implications for service delivery and training of therapists. In this study we used a novel approach to estimate the magnitude of the therapist contribution overall and the effect of individual therapist differences. We conducted a meta-analysis of studies in which participants were randomised to receive the same treatment either through self-help or through a therapist. We identified a total of 15 studies (commencement N = 910; completion N = 723) meeting inclusion criteria. We found no difference in treatment completion rate and broad equivalence of treatment outcomes for participants treated through self-help and participants treated through a therapist. Also, contrary to our expectations, we found that the variability of outcomes was broadly equivalent, suggesting that differences in efficacy of individual therapists were not sufficient to make therapy outcomes more variable when a therapist was involved. Overall, the findings suggest that self-help, with minimal therapist input, has considerable potential as a first-line intervention. The findings did not suggest that individual differences between therapists play a major role in psychotherapy outcome. PubDate: 2017-09-01 DOI: 10.1007/s10488-016-0783-9 Issue No:Vol. 44, No. 5 (2017)
Authors:Kerry K. Prout; M. Scott DeBerard Pages: 681 - 690 Abstract: Abstract The current study investigated therapist demographic and level of experience in relation to psychotherapy outcomes for adult and child clients. The OQ-45 and Y-OQ 2.01 were used to assess outcomes for 199 adults and 169 youth clients seen for psychotherapy by graduate-level student therapists. Analyses included calculation of Pearson correlation coefficients for each therapist-specific factors (e.g., therapist age, sex) and total score change amount on the OQ-45/Y-OQ 2.01 by treatment outcome subgroup (e.g., clinically significant change, reliable improvement, no change, or deterioration). For adults, a statistically significant relationship was found between improved outcomes and therapist having previously obtained clinical master’s degree (r = 0.276, p < .05) as well as female therapist gender (r = −0.295, p < .05). For youth, no statistically significant correlations were observed. Current findings are compared to nontraining settings and implications for student therapist training and training clinic policy are reviewed. PubDate: 2017-09-01 DOI: 10.1007/s10488-017-0798-x Issue No:Vol. 44, No. 5 (2017)
Authors:Jo-Ann Pereira; Michael Barkham; Stephen Kellett; David Saxon Pages: 691 - 704 Abstract: Abstract A growing body of literature attests to the existence of therapist effects with little explanation of this phenomenon. This study therefore investigated the role of resilience and mindfulness as factors related to practitioner wellbeing and associated effective practice. Data comprised practitioners (n = 37) and their patient outcome data (n = 4980) conducted within a stepped care model of service delivery. Analyses employed benchmarking and multilevel modeling to identify more and less effective practitioners via yoking of therapist factors and nested patient outcomes. A therapist effect of 6.7 % was identified based on patient depression (PHQ-9) outcome scores. More effective practitioners compared to less effective practitioners displayed significantly higher levels of mindfulness as well as resilience and mindfulness combined. Implications for policy, research and practice are discussed. PubDate: 2017-09-01 DOI: 10.1007/s10488-016-0747-0 Issue No:Vol. 44, No. 5 (2017)
Authors:James F. Boswell; Michael J. Constantino; David R. Kraus Pages: 724 - 728 Abstract: Abstract In this commentary, we address the critical importance of the research literature documenting therapist differences in skill and outcomes. In particular, we focus on the implications of therapist differences for patient-centered decision making, including the matching of patients to specific psychotherapists who have empirically-based track records of positive performance. In addition, we present preliminary results from a grant supported study of patients’ values and preferences regarding the use of provider performance track records in routine mental health care decision making. PubDate: 2017-09-01 DOI: 10.1007/s10488-016-0789-3 Issue No:Vol. 44, No. 5 (2017)
Authors:Scott D. Miller; Mark A. Hubble; Bruce E. Wampold Pages: 732 - 734 PubDate: 2017-09-01 DOI: 10.1007/s10488-017-0805-2 Issue No:Vol. 44, No. 5 (2017)
Authors:Jack Tsai; Wesley J. Kasprow; Jeffrey L. Quarles; Rani A. Hoff Pages: 747 - 755 Abstract: Abstract Transition-in-Place (TIP) is a housing model being piloted in the veterans affairs transitional housing program, Grant & Per Diem (GPD). This observational 20-site study compares characteristics and outcomes of 488 clients in TIP and 10,388 clients in traditional GPD programs. TIP participants were younger, better educated, healthier, and reported higher employment income than traditional GPD participants. Adjusting for these differences, TIP participants were more likely to have their own housing and reported higher employment and public support income at program exit, although the differences were small. These results inform use of the TIP model as a public health intervention. PubDate: 2017-09-01 DOI: 10.1007/s10488-016-0756-z Issue No:Vol. 44, No. 5 (2017)
Authors:Suzie S. Weng; Jennifer Spaulding-Givens Pages: 771 - 781 Abstract: Abstract This qualitative study used snowball sampling of individuals known to provide informal assistance to Asian American community members with their mental health problems in a locality in the South where there has been an exponential increase of the Asian American population. The major themes found include: (1) the existence of cultural, language, knowledge, and transportation barriers and the importance of policy in addressing them; (2) the impact of the model minority myth and the need for inclusive policymaking; and (3) the unique service and policy needs of immigrants. Findings demonstrate the importance and value of including diverse Asian American individuals in mental health policymaking efforts. PubDate: 2017-09-01 DOI: 10.1007/s10488-016-0784-8 Issue No:Vol. 44, No. 5 (2017)
Authors:Todd Gilmer; Benjamin Henwood; Nicole McGovern; Samantha Hurst; James Burgdorf; Debbie Innes-Gomberg Pages: 782 - 791 Abstract: Abstract Underrepresented racial/ethnic populations (UREPs) face disparities in their use of behavioral health services for multiple reasons including lack of culturally competent services and stigma. This paper employs mixed methods to compare health outcomes and costs among clients in 14 culturally competent behavioral health programs targeting specific UREPs to five programs without a specific racial or ethnic focus. We found that UREP-focused programs were associated with similar improvements in health outcomes, but greater costs relative to the comparison programs. Main themes from the qualitative analysis included: addressing stigma, building trust and understanding confidentiality, looking for a cure, and moving beyond linguistic competency. PubDate: 2017-09-01 DOI: 10.1007/s10488-016-0786-6 Issue No:Vol. 44, No. 5 (2017)
Authors:Emma M. Sterrett-Hong; Eli Karam; Lynn Kiaer Pages: 792 - 809 Abstract: Abstract Many community mental health (CMH) systems contain inefficiencies, contributing to unmet need for services among youth. Using a quasi-experimental research design, we examined the implementation of an adapted structural-strategic family intervention, Parenting with Love and Limits, in a state CMH system to increase efficiency of services to youth with co-existing internalizing and externalizing functional impairments (PLL n = 296; Treatment-As-Usual n = 296; 54% male; 81% Caucasian). Youth receiving PLL experienced shorter treatment durations and returned to CMH services at significantly lower rates than youth receiving treatment-as-usual. They also demonstrated significant decreases in internalizing and externalizing symptoms over time. Findings lay the foundation for further examination of the role of an adapted structural-strategic family treatment in increasing the efficiency of CMH systems. PubDate: 2017-09-01 DOI: 10.1007/s10488-016-0788-4 Issue No:Vol. 44, No. 5 (2017)
Authors:Angela L. Rollins; Marina Kukla; Michelle P. Salyers; John H. McGrew; Mindy E. Flanagan; Doug L. Leslie; Marcia G. Hunt; Alan B. McGuire Pages: 810 - 816 Abstract: Abstract Successful implementation of evidence-based practices requires valid, yet practical fidelity monitoring. This study compared the costs and acceptability of three fidelity assessment methods: on-site, phone, and expert-scored self-report. Thirty-two randomly selected VA mental health intensive case management teams completed all fidelity assessments using a standardized scale and provided feedback on each. Personnel and travel costs across the three methods were compared for statistical differences. Both phone and expert-scored self-report methods demonstrated significantly lower costs than on-site assessments, even when excluding travel costs. However, participants preferred on-site assessments. Remote fidelity assessments hold promise in monitoring large scale program fidelity with limited resources. PubDate: 2017-09-01 DOI: 10.1007/s10488-016-0785-7 Issue No:Vol. 44, No. 5 (2017)
Authors:Ilaria Montagni; Luis Salvador-Carulla; David Mcdaid; Christa Straßmayr; Florian Endel; Petri Näätänen; Jorid Kalseth; Birgitte Kalseth; Tihana Matosevic; Valeria Donisi; Karine Chevreul; Amélie Prigent; Raluca Sfectu; Carmen Pauna; Mencia R. Gutiérrez-Colosia; Francesco Amaddeo; Heinz Katschnig Abstract: Abstract Comparing mental health systems across countries is difficult because of the lack of an agreed upon terminology covering services and related financing issues. Within the European Union project REFINEMENT, international mental health care experts applied an innovative mixed “top-down” and “bottom-up” approach following a multistep design thinking strategy to compile a glossary on mental health systems, using local services as pilots. The final REFINEMENT glossary consisted of 432 terms related to service provision, service utilisation, quality of care and financing. The aim of this study was to describe the iterative process and methodology of developing this glossary. PubDate: 2017-09-16 DOI: 10.1007/s10488-017-0826-x
Authors:Charles E. Cunningham; Melanie Barwick; Heather Rimas; Stephanie Mielko; Raluca Barac Abstract: Abstract Using an online, cross sectional discrete choice experiment, we modeled the influence of 14 implementation attributes on the intention of 563 providers to adopt hypothetical evidence-based children’s mental health practices (EBPs). Latent class analysis identified two segments. Segment 1 (12%) would complete 100% of initial training online, devote more time to training, make greater changes to their practices, and introduce only minor modifications to EBPs. Segment 2 (88%) preferred fewer changes, more modifications, less training, but more follow-up. Simulations suggest that enhanced supervisor support would increase the percentage of participants choosing the intensive training required to implement EBPs. The dissemination of EBPs needs to consider the views of segments of service providers with differing preferences regarding EBPs and implementation process design. PubDate: 2017-09-16 DOI: 10.1007/s10488-017-0824-z
Authors:Joshua Breslau; Emily Leckman-Westin; Hao Yu; Bing Han; Riti Pritam; Diana Guarasi; Marcela Horvitz-Lennon; Deborah M. Scharf; Harold A. Pincus; Molly T. Finnerty Abstract: Abstract We examine the impact of mental health based primary care on physical health treatment among community mental health center patients in New York State using propensity score adjusted difference in difference models. Outcomes are quality indicators related to outpatient medical visits, diabetes HbA1c monitoring, and metabolic monitoring of antipsychotic treatment. Results suggest the program improved metabolic monitoring for patients on antipsychotics in one of two waves, but did not impact other quality indicators. Ceiling effects may have limited program impacts. More structured clinical programs to may be required to achieve improvements in quality of physical health care for this population. PubDate: 2017-09-07 DOI: 10.1007/s10488-017-0822-1
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