More Practice, Less Preach? The Role of Supervision Processes and Therapist Characteristics in EBP Implementation

Identifying predictors of evidence-based practice (EBP) use, such as supervision processes and therapist characteristics, may support dissemination. Therapists (N = 57) received training and supervision in EBPs to treat community-based youth (N = 136). Supervision involving modeling and role-play predicted higher overall practice use than supervision involving discussion, and modeling predicted practice use in the next therapy session. No therapist characteristics predicted practice use, but therapist sex and age moderated the supervision and practice use relation. Supervision involving discussion predicted practice use for male therapists only, and modeling and role-play in supervision predicted practice use for older, not younger, therapists.     

Not Just a Walk in the Park: Efficacy to Effectiveness for After School Programs in Communities of Concentrated Urban Poverty

This study examined a model for mental health consultation, training and support designed to enhance the benefits of publicly-funded recreational after-school programs in communities of concentrated urban poverty for children’s academic, social, and behavioral functioning. We assessed children’s mental health needs and examined the feasibility and impact of intervention on program quality and children’s psychosocial outcomes in three after-school sites (n = 15 staff, 89 children), compared to three demographically-matched sites that received no intervention (n = 12 staff, 38 children). Findings revealed high staff satisfaction and feasibility of intervention, and modest improvements in observed program quality and staff-reported children’s outcomes. Data are considered with a public health lens of mental health promotion for children in urban poverty.     

Impact of Cognitive Behavioral Therapy on Observed Autism Symptom Severity During School Recess: A Preliminary Randomized,Controlled Trial

This study compared cognitive behavioral therapy (CBT) and treatment-as-usual (TAU) in terms of effects on observed social communication-related autism symptom severity during unstructured play time at school for children with autism spectrum disorders (ASD). Thirteen children with ASD (7–11 years old) were randomly assigned to 32 sessions of CBT or community-based psychosocial treatment (TAU) for 16 weeks. The CBT program is based on the memory retrieval competition model and emphasizes the development of perspective-taking through guided behavioral experimentation supplemented with reflective Socratic discussion and supported by parent training and school consultation to promote generalization of social communication and emotion regulation skills. Trained observers blind to treatment condition observed each child during recess on two separate days at baseline and again at posttreatment, using a structured behavioral observation system that generates frequency scores for observed social communication-related autism symptoms. CBT outperformed TAU at posttreatment on the frequency of self-isolation, the proportion of time spent with peers, the frequency of positive or appropriate interaction with peers, and the frequency of positive or appropriate peer responses to the target child (d effect size range 1.34–1.62). On average, children in CBT were engaged in positive or appropriate social interaction with peers in 68.6 % of observed intervals at posttreatment, compared to 25 % of intervals for children in TAU. Further investigation of this intervention modality with larger samples and follow-up assessments is warranted.     

Virtual Reality Job Interview Training in Adults with Autism Spectrum Disorder

The feasibility and efficacy of virtual reality job interview training (VR-JIT) was assessed in a single-blinded randomized controlled trial. Adults with autism spectrum disorder were randomized to VR-JIT (n = 16) or treatment-as-usual (TAU) (n = 10) groups. VR-JIT consisted of simulated job interviews with a virtual character and didactic training. Participants attended 90 % of laboratory-based training sessions, found VR-JIT easy to use and enjoyable, and they felt prepared for future interviews. VR-JIT participants had greater improvement during live standardized job interview role-play performances than TAU participants (p = 0.046). A similar pattern was observed for self-reported self-confidence at a trend level (p = 0.060). VR-JIT simulation performance scores increased over time (R ² = 0.83). Results indicate preliminary support for the feasibility and efficacy of VR-JIT, which can be administered using computer software or via the internet.     

The influence of psychodrama on promoting self-disclosure in groups of university students

The purpose of this study was to investigate the influence of psychodrama on self-disclosure, which is an important skill of interpersonal relationships.It was carried out with a group of university students (5 females, 3 males) and comprised 13 psychodrama sessions. Each session lasted for 4 h and all the members were unmarried. Two psychodrama psychotherapists participated in the sessions alternating their therapist and co-therapist roles each session. Six of the sessions were group plays or sociodrama, five of the sessions were protagonist plays. One of the sessions explored “the meaning of the life” by using the objects in the room; each member explained the reason why s/he had chosen a certain object and what it meant to her/him. The last session was the “magic shop” game.“Jourard Self-Disclosure Inventory” (Selçuk, ?nsan ?li?kilerinde Kendini Açma (Self-disclosure in Interpersonal Relationships), Vadi Yay?nc?l?k, Ankara, 1992; Öner, Türkiye’de Kullan?lan Psikolojik Testler. (Psychological Tests Used in Turkey) 3. Bask?, Bo?aziçi Üniversitesi Yay?nlar?, ?stanbul, pp 398–399, 1997) and “The Communication Skills Evaluation Scale” (Korkut, The Journal Of Psychological Counselling And Guidance, 2(7)18–23, 1996a) were applied to the students at the beginning of the sessions. These tests were repeated at the end of the psychodrama process in order to observe the influence of psychodrama on the scores. It was confirmed that university students’ self-disclosure scores were increased by psychodrama. As the students evaluated their interpersonal communication skills during this period, they became aware of their need for developing higher communication skills. The author concludes that awareness of communication skills was raised via psychodrama and that psychodrama is a useful method for increasing and developing self-disclosure.     

Training patients with schizophrenia to share decisions with their psychiatrists: a randomized-controlled trial

Purpose

Many patients with schizophrenia have a desire for shared decision-making (SDM). However, in clinical practice SDM often does not take place. One cause might be that many patients behave passively in the medical encounter, therefore not facilitating SDM. It was the aim of the study to evaluate the effects of a patient directed SDM-training on patients’ communicative behavior in the consultation, their attitudes towards decision-making and their long-term adherence.

Methods

Randomized-controlled trial comparing a five-session SDM-training for inpatients with schizophrenia with five sessions of non-specific group training. The SDM-training sessions included motivational (e.g. prospects of participation, patient rights) and behavioral aspects (e.g. role plays) and addressed important aspects of the patient–doctor interaction such as question asking or giving feedback.

Results

N = 264 patients were recruited in four psychiatric hospitals in Germany. The SDM-training yielded no group differences regarding the main outcome measure (treatment adherence) at 6 and 12 months after discharge. However, there were short-term effects on patients’ participation preferences, their wish to take over more responsibility for medical decisions and (according to their psychiatrists’ estimate) their behavior in psychiatric consultations.

Conclusions

While there was no effect regarding treatment adherence, the shared decision-making training for inpatients with schizophrenia has been shown to increase patients’ active behavior in psychiatric consultations during their inpatient treatment. When implemented it should be combined with complementary SDM interventions (decision support tools and communication training for professionals) to yield maximum effects.

     

Improving peer supervisor ratings of therapist performance in dialectical behavior therapy: An Internet-based training system

The present study involved the development of an Internet-based training system (ITS) to help train peer supervisors. The system, which was piloted with Dialectical Behavior Therapy (Linehan, 1993) using mock sessions, demonstrates how Internet-based technology can facilitate training protocols to support the ongoing training and supervision of therapists efficiently. Participant evaluation of the system was very positive, with over 90% of respondents reporting that they believed that the ITS was very useful or extremely useful for therapist training. Possible uses of the system include: (a) helping therapists to learn to discriminate more effective from less effective interventions to provide better feedback to supervisees and peers on their sessions, (b) helping therapists to improve their own ability to monitor and deliver a treatment effectively, and (c) helping to structure therapist training and supervision activities. The system could also be used to help with real-world supervision of therapists, assuming that legal and ethical issues associated with the use of the Internet for clinical supervision are addressed adequately. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

Effectiveness and Sustainability of School-Based Interventions for Youth with or at Risk for ADHD

In a pre–post design study, we examined the effectiveness and sustainability of a school mental health program for youth with or at-risk for ADHD (n = 41) when implemented over the course of 4 years by district-employed school mental health professionals (SMHPs) in a rural community. In the program, children received a daily report card (DRC) intervention and teachers received behavioral consultation sessions twice a month. Parent and teacher ratings of symptoms and impairment were collected at pre-intervention (typically fall) and post-intervention (spring) of each academic year. According to parent ratings, children experienced significant improvement in academic functioning (effect size (ES) = .65) and overall functioning (ES = .57). Changes in parent-rated symptoms were in the expected direction, but small in magnitude (ranged from .22 to .32) and nonsignificant. Changes in teacher ratings of symptoms and impairment were nonsignificant. The ESs ranged from ?.12 (self-esteem) to .42 (inattention). Results are discussed in the context of current efforts to disseminate treatments for youth with ADHD and disruptive behavior disorders.     

Consultation as an Implementation Strategy for Evidence-Based Practices Across Multiple Contexts: Unpacking the Black Box

There is great interest in the dissemination and implementation of evidence-based treatments and practices for children across schools and community mental health settings. A growing body of literature suggests that the use of one-time workshops as a training tool is ineffective in influencing therapist behavior and patient outcomes and that ongoing expert consultation and coaching is critical to actual uptake and quality implementation. Yet, we have very limited understanding of how expert consultation fits into the larger implementation support system, or the most effective consultation strategies. This commentary reviews the literature on consultation in child mental health, and proposes a set of core consultation functions, processes, and outcomes that should be further studied in the implementation of evidence-based practices for children.     

Effects of Equine Assisted Activities on Autism Spectrum Disorder

Quality of life assessments were used in this study to determine the behavioral changes of children diagnosed with autism spectrum disorder (ASD) who participated in equine assisted activities. Behavioral changes of children with ASD participating in 9 weeks of equines assisted activities (EAA) (N = 10) were compared to behavioral changes of children who participated in a non-equine intervention (N = 8). Parents noted significant improvements in their child’s physical, emotional and social functioning following the first 6 weeks of EAA. The children participating in the non-equine program also demonstrated improvement in behavior, but to a lesser degree. The favorable outcome of this study lends support for continuation of programs utilizing EAA in the treatment of children with ASD.     

Role-Play Assessment of Therapist Adherence and Skill in Implementation of Trauma-Focused Cognitive-Behavioral Therapy

Numerous efforts are underway to train clinicians in evidence-based practices. Unfortunately, the field has few practical measures of therapist adherence and skill with which to judge the success of these training and implementation efforts. One possible assessment method is using behavioral rehearsal, or role-play, as an analogue for therapist in-session behavior. The current study describes aspects of reliability, validity and utility of a behavioral role-play assessment developed to evaluate therapist adherence and skill in implementing Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT). TF-CBT role-play assessments were conducted with a sample of 43 therapists as part of a larger training study. The TF-CBT role-play assessments were independently coded for TF-CBT adherence and skill by a certified TF-CBT trainer and three clinical psychology doctoral students. Findings indicated good interrater reliability for the individual items (ICC: M?=?.71, SD?=?.15). Regarding utility, 67.19% (n?=?43/64) of contacted therapists completed the role-play assessment, which took an average of 30 min (M?=?31.42, SD?=?5.65) to complete and 60 min (M?=?62.84, SD?=?11.31) to code. Therapists with a master’s degree were more likely to complete the role-play assessment than those with other degrees but no other differences in demographic variables, practice characteristics, or TF-CBT knowledge or training were found between participants and nonparticipants. Role-play assessments may offer an alternative to observational coding for assessing therapist adherence and skill, particularly in contexts where session recordings are not feasible.

     

Intensive Cognitive Behavioral Therapy for Anxiety Disorders in School-aged Children with Autism: A Preliminary Comparison with Treatment-as-Usual

Children with autism spectrum disorders (ASDs) frequently present with a comorbid anxiety disorder that can cause significant functional impairment, particularly at school. An intensive modular cognitive behavioral treatment (CBT) program was delivered to address anxiety, self-regulation, and social engagement in school and in the community. A particular emphasis was placed on increasing generalizability of coping skills and positive social behavior by involving school personnel in the treatment process. Children (7–11 years old) were randomly assigned to an immediate treatment condition (IT) that included 32 sessions of CBT (n = 7) or a 16-week treatment-as-usual (TAU) condition (n = 5). The CBT sessions emphasized behavioral experimentation and emotion regulation training as well as social coaching on increasing positive peer interactions. School observations and consultations were included in the treatment model. Independent evaluators blind to treatment condition conducted structured diagnostic interviews at baseline and post-IT/post-TAU. Post-treatment analyses showed that 71.4 % of the IT group had remitted from their primary anxiety disorder diagnosis as compared with none of the TAU group. In addition, an ANCOVA analysis conducted with baseline anxiety scores included as a covariate revealed a statistically significant difference by treatment group in anxiety severity favoring the IT group at post-treatment. The 32-session CBT program is an intensive approach for children with ASD and moderate-to-severe anxiety disorders that appears to yield a clinically significant impact on anxiety symptoms. The generalizability of coping skills may be enhanced by the inclusion of school-based treatment components due to the consistency of supports this permits across the child’s daily settings.     

Changes in Mental Health Providers’ Recovery Attitudes and Strengths Model Implementation Following Training and Supervision

The strengths model (SM) is a recovery-oriented model of mental health care. Historically, training alone has been insufficient to ensure implementation of SM skills in practice. The aim of the current study was to determine whether improvements in recovery attitudes and attendance at Strength-Based Group Supervision (SBGS) following training are associated with greater skill implementation in practice. Mental health providers (N = 76) were trained in SM interventions and surveyed immediately before and after training and at a 6-month follow-up on various recovery attitude measures and SBGS attendance. Results showed that providers’ attitudes were significantly improved after completing the training programs; however, only willingness to support consumers in positive goal-oriented risk taking remained significantly improved at 6-month follow-up. The frequency of attendance at SBGS sessions was low, and this may have contributed to a lack of consistent evidence that SBGS attendance was associated with sustained improvements in attitudes or SM skill implementation. Future research is needed to clarify the ability of public sector mental health organizations to successfully implement and sustain SM approaches in practice. The role of ongoing SBGS in this process also requires continued investigation.

     

Therapist Attitudes Towards Computer-Based Trainings

Computer-based trainings are a promising avenue for increasing access to training in evidence-based practices. However, little is known about whether therapists are willing to use them. Results from a national survey of practicing therapists (N = 1,067) indicated that 26 % of therapists reported previously using a computer-based training and overall attitudes (as measured by the Computer-Based Training Attitudes Scale) were positive. Higher therapist computer fluency and greater openness to new treatments predicted positive attitudes. Therapists with more positive attitudes were more likely to have previously used a computer-based training. Implications are discussed.     

Effects of aerobic exercise on cognitive performance and individual psychopathology in depressive and schizophrenia patients

Cognitive deficits are core symptoms in patients with schizophrenia (SZ) and major depressive disorder (MDD), but specific and approved treatments for cognitive deterioration are scarce. Experimental and clinical evidence suggests that aerobic exercise may help to reduce psychopathological symptoms and support cognitive performance, but this has not yet been systematically investigated. In the current study, we examined the effects of aerobic training on cognitive performance and symptom severity in psychiatric inpatients. To our knowledge, to date, no studies have been published that directly compare the effects of exercise across disease groups in order to acquire a better understanding of disease-specific versus general or overlapping effects of physical training intervention. Two disease groups (n = 22 MDD patients, n = 29 SZ patients) that were matched for age, gender, duration of disease and years of education received cognitive training combined either with aerobic physical exercise or with mental relaxation training. The interventions included 12 sessions (3 times a week) over a time period of 4 weeks, lasting each for 75 min (30 min of cognitive training + 45 min of cardio training/mental relaxation training). Cognitive parameters and psychopathology scores of all participants were tested in pre- and post-testing sessions and were then compared with a waiting control group. In the total group of patients, the results indicate an increase in cognitive performance in the domains visual learning, working memory and speed of processing, a decrease in state anxiety and an increase in subjective quality of life between pre- and post-testing. The effects in SZ patients compared with MDD patients were stronger for cognitive performance, whereas there were stronger effects in MDD patients compared with SZ patients in individual psychopathology values. MDD patients showed a significant reduction in depressive symptoms and state anxiety values after the intervention period. SZ patients reduced their negative symptoms severity from pre- to post-testing. In sum, the effects for the combined training were superior to the other forms of treatment. Physical exercise may help to reduce psychopathological symptoms and improve cognitive skills. The intervention routines employed in this study promise to add the current psychopathological and medical treatment options and could aid the transition to a multidisciplinary approach. However, a limitation of the current study is the short time interval for interventions (6 weeks including pre- and post-testing).     

Informal aphasia assessment,interaction and the development of the therapeutic relationship in the early period after stroke

Background: Speech pathologists tend to favour informal assessment over formal, standardised batteries in the acute/sub-acute hospital setting, often using their own local screening tools, subtests or non-standardised assessments. Despite the tendency to use informal assessment measures, little research has been done on what might characterise informality in assessment.

Aims: Using a systemic functional linguistics framework and thematic analysis of interview data, the aims of this study were to explore interactions during informal assessment, the balance of clinician-centred and client-centred interactions during sessions and their impact on the development of the therapeutic relationship.

Methods and Procedures: This small study sought to capture authentic initial and review informal assessment sessions and involved three men with aphasia (74 years/3 weeks post; 48 years/6 weeks post; 80 years/4 days post), who happened to be on the caseload of a single therapist at the time of the study. Inclusion criteria were the ability to provide consent (with communication support if necessary), to be inpatients within the first 12 weeks post-stroke, with no psychiatric history or dementia. Videos of three aphasia assessment sessions were collected, with recorded reflective interviews with the therapist, and two of the patients, following each one. Assessment sessions were transcribed and then analysed in full for their speech function moves. Both synoptic analysis (quantifying choices per speaker) and dynamic analysis (looking at choices through the exchange) were carried out. The exchanges were also considered in the light of the issues raised in the reflective interviews.

Outcomes and Results: While all the assessment sessions were typically controlled by the therapist and had sections which followed the classic request, response, evaluation type pattern, there were examples of dynamic assessment and of casual conversation including a range of moves to introduce new material and humour. The clinician’s reflections highlighted the need to individualise sessions, integrate assessment and therapy, and reveal competence and areas of retained ability.

Conclusions: This work highlights the importance of distinguishing between informal assessment measures/tools and informal assessment interaction. It shows the efforts both therapists and patients make to normalise or casualise their interactions within the potentially awkward context of testing, and has implications for how to make the best therapeutic use of the time spent in early aphasia assessment. The tendency to use informal assessments along with informality in exchanges reflects relationship building required for therapy.     

IDEM-dépression : caractéristiques et évaluation d’un groupe ouvert combinant psycho-éducation et thérapie cognitivo-comportementale

Introduction

Depression is a highly prevalent mental illness that is associated with high rates of morbidity and functional impairment. At the psychiatric unit of the University Hospital of Strasbourg, France, we have developed an open group that combines psychoeducation and cognitive-behavior therapy (CBT), the information, discovery, exchange and mobilization for depression group (IDEM-depression). IDEM-depression is composed of 17 thematic, structured, and independent sessions, which address different aspects of depression (i.e., rumination, pharmacological treatments). Because of its flexible format, patients with varying degrees of depression severity (from remission up to severe depressive symptoms) and whose depression might be bipolar or unipolar, are able to participate in the group. Thus, the group is well suited to a large number of patients with major depression. In the present study we aimed at describing the IDEM-depression group and presenting results regarding patients’ overall satisfaction, assessed via two self-report questionnaires (the Client Satisfaction Questionnaire, the CSQ-8, and the IDEM ad hoc questionnaire), as well as its effect on mood following each session assessed via a visual analog scale (VAS) ranging from 0 up to 100.

Behavioral activation for late adolescents with subthreshold depression: a randomized controlled trial

The main behavioral characteristic of subthreshold depression that is observed in adolescents is the low frequency of exposure to environmental rewards. Therefore, it was considered that a simple intervention conducted in short sessions, focusing on increasing access to positively reinforcing activities, would be efficacious in increasing the availability of rewards. We conduct a randomized controlled trial to examine the efficacy of such a behavioral activation program that was conducted weekly for 5 weeks in 60-min sessions. Late adolescent university students aged 18–19 years with subthreshold depression were randomly allocated to a treatment (n = 62) or a control group (n = 56). The primary outcome of the study was the Beck Depression Inventory-II score. Results indicated that late adolescent students in the treatment group showed significant improvements in their depressive symptoms (effect size ?0.90, 95 % CI ?1.28 to ?0.51) compared to the control group. Students in the treatment group also showed significant improvements in self-reported rating of quality of life and in behavioral characteristics. It is concluded that this intervention had a large and significant effect despite being short and simple and that this low-intensity cognitive behavioral therapy program could be conducted in many different types of institutions. It is suggested that the long-term effects of the treatment program should be targeted for investigation in future studies.     

What Did They Learn? Effects of a Brief Cognitive Behavioral Therapy Workshop on Community Therapists’ Knowledge

Knowledge gain has been identified as necessary but not sufficient for therapist behavior change. Declarative knowledge, or factual knowledge, is thought to serve as a prerequisite for procedural knowledge, the how to knowledge system, and reflective knowledge, the skill refinement system. The study aimed to examine how a 1-day workshop affected therapist cognitive behavioral therapy declarative knowledge. Participating community therapists completed a test before and after training that assessed cognitive behavioral therapy knowledge. Results suggest that the workshop significantly increased declarative knowledge. However, post-training total scores remained moderately low, with several questions answered incorrectly despite content coverage in the workshop. These findings may have important implications for structuring effective cognitive behavioral therapy training efforts and for the successful implementation of cognitive behavioral therapy in community settings.     

Investigating the influence of paired-associative stimulation on multi-session skill acquisition and retention in older adults

ObjectivePriming non-invasive brain stimulation (NIBS) can improve motor learning in the elderly, but it remains unclear how benefits observed in a single training session translate to multiple training sessions. The current study therefore examined the influence of priming NIBS on acquisition and retention of a novel motor skill over sequential training days in older adults.MethodsIn 30 older adults (68.2 ± 5.3 years, 14 females), paired-associative stimulation (PAS) was applied prior to visuomotor training on 3 consecutive days. The interstimulus interval used for PAS was either 10 ms (PAS_LTD) or 100 ms (PAS_Control) and long-term retention was assessed by quantifying motor performance 7 days after the final training session.ResultsDuring training, skill progressively increased across sessions (P < 0.0001), but this was not different between PAS_LTD and PAS_Control (P > 0.1). In contrast, the magnitude of skill retained 7 days after training was significantly greater in the PAS_LTD group (P = 0.02), suggesting significantly greater long-term retention of the trained skill.ConclusionsPAS_LTD over multiple sessions may represent an effective tool to help maintain newly learned motor skills in older adults.SignificanceWhile multisession priming with PAS can influence long-term skill retention, improving skill acquisition requires investigation of alternative protocols.