The Reinforcing Therapist Performance (RTP) experiment: Study protocol for a cluster randomized trial

<p>Abstract</p> <p>Background</p> <p>Rewarding provider performance has been recommended by the Institute of Medicine as an approach to improve the quality of treatment, yet little empirical research currently exists that has examined the effectiveness and cost-effectiveness of such approaches. The aim of this study is to test the effectiveness and cost-effectiveness of providing monetary incentives directly to therapists as a method to improve substance abuse treatment service delivery and subsequent client treatment outcomes.</p> <p>Design</p> <p>Using a cluster randomized design, substance abuse treatment therapists from across 29 sites were assigned by site to either an implementation as usual (IAU) or pay-for-performance (P4P) condition.</p> <p>Participants</p> <p>Substance abuse treatment therapists participating in a large dissemination and implementation initiative funded by the Center for Substance Abuse Treatment.</p> <p>Intervention</p> <p>Therapists in both conditions received comprehensive training and ongoing monitoring, coaching, and feedback. However, those in the P4P condition also were given the opportunity to earn monetary incentives for achieving two sets of measurable behaviors related to quality implementation of the treatment.</p> <p>Outcomes</p> <p>Effectiveness outcomes will focus on the impact of the monetary incentives to increase the proportion of adolescents who receive a targeted threshold level of treatment, months that therapists demonstrate monthly competency, and adolescents who are in recovery following treatment. Similarly, cost-effectiveness outcomes will focus on cost per adolescent receiving targeted threshold level of treatment, cost per month of demonstrated competence, and cost per adolescent in recovery.</p> <p>Trial Registration</p> <p>Trial Registration Number: NCT01016704</p

Organizational factors and therapist attitudes in the prediction of MI adoption.

Dissemination efforts occur within a context. It is important to determine the individual and organizational factors that promote MI adoption. The present study had three goals: 1) to examine the four-factor structure of the Evidence-Based Practice Attitudes Scale (EBPAS) in a sample of substance abuse providers, 2) to examine the organizational and therapist attitude variables that predicted study attrition, and 3) to examine the organizational and therapist attitude factors that predicted MI skill levels at each of the three time points and the factors that predicted skill growth over time. While the factor-structure of the EBPAS was similar in this sample to a sample of general mental health practitioners, the model fit the data only marginally well. More positive therapist attitudes about EBP and positive organizational climate predicted submission of a three-month follow-up session. Institutional resources and training exposure and utilization predicted both skill growth over time and skill level at baseline, immediately post-training, and three-months post-training. In order to more effectively adopt MI, an organization needs to be appropriately funded and devote more resources to exposing therapists to continuing education opportunities

Healing historical trauma in Native American communities: a liberation psychology approach to wellness

This critical analysis of the literature explores the potential of liberation psychology to address the sequelae of historical trauma in Native American communities. 21st century Native America faces significant health and wellness challenges including socio-economic disparities, interpersonal violence, substance abuse, psycho-spiritual distress, and physical health issues (Brave Heart, 2004; Dickerson & Johnson, 2010; Manson, 2000; Manson, Beals, Klein, Croy, & AI-SUPERPFP, 2005; United States Department of Health and Human Services, 2001). The literature questions the validity of mainstream psychological science to effectively conceptualize and treat Native Americans, and calls for the identification of specific, culturally relevant interventions to increase physical and psychological wellness (Duran, 2006; Manson, 2000; Wendt & Gone, 2011). The concept of historical trauma helps to elucidate the psycho-spiritual distress experienced by many Native Americans, including internalized oppression, as the sequelae of unhealed wounds from 500 years of physical and cultural genocide (Brave Heart, Chase, Elkins, & Altschul, 2011; Duran, 2006; Gone & Alcantara, 2007; Manson, 2000; Struthers & Lowe, 2003; Whitbeck, 2006). Duran, Firehammer, and Gonzalez (2008) suggest a liberation psychology approach may alleviate suffering related to historical trauma. This dissertation further integrates the literature on the historical trauma response with the literature on liberation psychology. Native American wellness goals are identified in the literature of scholars, researchers, practitioners, activists, community members, and allies. Concepts and strategies from a liberation psychology framework are then explored for their potential to help illuminate challenges, address needs, and support goals, in alignment with cultural values and work currently being done in this field. Implications in the areas of epistemology, research, clinical practice, practitioner training, and public acknowledgement are explored in depth, and recommendations for incorporating liberatory strategies in therapeutic interventions are made. This dissertation also identifies its own theoretical and methodological limitations, and proposes areas for future investigation. Emerging hypotheses suggest that incorporating liberatory practices in therapeutic work with Native American communities may offer a congruent and compatible pathway to promote psychological well-being in this community

Current insights of community mental healthcare for people with severe mental illness:A scoping review

Background: For the last four decades, there has been a shift in mental healthcare toward more rehabilitation and following a more humanistic and comprehensive vision on recovery for persons with severe mental illness (SMI). Consequently, many community-based mental healthcare programs and services have been developed internationally. Currently, community mental healthcare is still under development, with a focus on further inclusion of persons with enduring mental health problems. In this review, we aim to provide a comprehensive overview of existing and upcoming community mental healthcare approaches to discover the current vision on the ingredients of community mental healthcare.Methods: We conducted a scoping review by systematically searching four databases, supplemented with the results of Research Rabbit, a hand-search in reference lists and 10 volumes of two leading journals. We included studies on adults with SMI focusing on stimulating independent living, integrated care, recovery, and social inclusion published in English between January 2011 and December 2022 in peer-reviewed journals.Results: The search resulted in 56 papers that met the inclusion criteria. Thematic analysis revealed ingredients in 12 areas: multidisciplinary teams; collaboration within and outside the organization; attention to several aspects of health; supporting full citizenship; attention to the recovery of daily life; collaboration with the social network; tailored support; well-trained staff; using digital technologies; housing and living environment; sustainable policies and funding; and reciprocity in relationships.Conclusion: We found 12 areas of ingredients, including some innovative topics about reciprocity and sustainable policies and funding. There is much attention to individual ingredients for good community-based mental healthcare, but very little is known about their integration and implementation in contemporary, fragmented mental healthcare services. For future studies, we recommend more empirical research on community mental healthcare, as well as further investigation(s) from the social service perspective, and solid research on general terminology about SMI and outpatient support

How do integrative psychotherapists integrate? A qualitative exploration of tales from the trenches

This is a phenomenological study exploring the first-person lived experiences of 14 clinicians in their daily practices of integrative psychotherapy, in an Irish context. The data were gathered through semi-structured interviews lasting 50 minutes and investigated using Interpretative Phenomenological Analysis (IPA). Three master themes emerged: (1) Being an Integrative Practitioner (2) The Therapeutic Relationship – A Dynamic Process and (3) Identity – Personal and Individual. The findings confirm that integrative psychotherapy is a complex and idiosyncratic process. The therapy practices as described by participants differ to those as outlined in the literature. Participants use their prior, tacit knowledge of what worked previously, built up through a cycle of praxis, as a reference point for their practice. Integration is seen as combining different interventions and techniques. All consider listening as the mainstay of building the therapeutic relationship and the driver towards integration. There is an appreciation of multiple aspects of client problems and multiple ways these can be understood in theory and worked through using a variety of interventions and techniques. Tailoring their approaches to the needs of each client was seen as a key responsibility of the therapist. A pluralistic perspective is proposed as a structure for containing the myriad of theories and therapies that practitioners are struggling to incorporate into their practices. This also aims to address the lack of clarity and agreed definition within the field in general. Since integrative/eclectic approaches are increasingly popular internationally, it is difficult to isolate issues relating to integration without reference to the wider field of psychotherapy. The study produced some novel and surprising discoveries: the lack of a cohesive identity shared by integrative psychotherapists, and a view of self as not being a researcher, despite the fact that descriptions of their practices often suggested the opposite. Developing a practitioner-researcher outlook is considered of great significance to the profession. A spirit of open, collaborative inquiry and a therapeutic pluralism have been advanced as an apposite stance for the profession to adopt in proactively meeting the challenges within what is a dynamic and ever-evolving field of endeavour

Experiences and Perceptions of Mental Health Professionals Considered Effective in the Diagnosis and Treatment of Adults with Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder (ADHD) is a disorder that has been documented in medical and mental health literature for over 100 years (Still, 1902). ADHD is a neurobiological based disorder characterized by three major symptoms identified at clinical levels and validated by diagnostic criteria established for the diagnosis of children before the age of seven (Diagnostic and Statistical Manual of Mental Disorders, 4 th edition-Text Revision; DSM-IV; American Psychiatric Association, 2000). The three diagnostic criteria are inattention, impulsivity, and hyperactivity that have been observed at clinical levels. Because many signs of the disorder were believed to discontinue with maturity, it was originally believed that ADHD did not apply to adults (Nadeau, 1995). Barkley, Murphy, and Fischer (2008) argued that nearly 5% of adults or 11 million adults in the United States have been identified as ADHD adults. Research suggests that ADHD remains hidden in adults and the prevalence of other comorbid conditions further complicates diagnosis and treatment (Wasserstein, 2005). Due to a growing realization that adults can have ADHD, there is a pressing need for diagnosis and psychological treatment. Diagnosis and treatment options for this population are largely under researched. No qualitative studies have been located that have asked mental health professionals who have experience treating adults with ADHD about their practices. This study will explore the experiences and perceptions of mental health professionals who provide diagnosis and treatment to adults with ADHD. The DSM-IV (APA, 2000) was the diagnostic standard used and discussed by research participants during the majority of the study. The DSM-5 (APA, 2013) was introduced in May, 2013; the implications of these diagnostic changes are yet unrealized. It is anticipated the results of this study will contribute to the field to provide information on best practices in treating ADHD adults

THE EXPLORATION OF CLINICIANS’ LIVED EXPERIENCES IN CULTURALLY ADAPTING EMPIRICALLY SUPPORTED TREATMENTS FOR AMERICAN INDIAN AND ALASKA NATIVE POPULATIONS

This study investigated the lived experiences of clinicians who have culturally adapted Empirically Supported Treatments (EST) for American Indian/Alaskan Native (AI/AN) populations. The central research question for this investigation was: What is the experience of mental health providers in culturally adapting empirically supported treatments for American Indian and Alaska Native populations? A guided semi-structured interview protocol was used to interview eight participants. Giorgi’s descriptive phenomenological psychological method was used to develop a general psychological structure representing eight essential constituents. They are: developing an understanding of cultural adaptation, focusing on building and maintaining therapeutic relationships, immersion and engagement with community, experiencing conflict between Western and Indigenous epistemology, navigating the use of empirically supported treatments, supporting traditional and culturally developed ways of healing, clinicians’ ability to embody cultural humility and increase cultural competency, and coping with external factors. Implications for practitioners, treatment developers, funders, academic programs, clients, and the counseling field are provided. Lastly, recommendations derived directly from the data, arising from limitations of the study, based on delimitations, and those relevant to the research problem are discussed