Outer-context determinants in the sustainment phase of a reimbursement-driven implementation of evidence-based practices in children’s mental health services

Although there is increasing investment to implement evidence-based practices (EBPs) in public systems across the USA, continued or sustained use of EBPs after initial implementation remains a challenge. The low integration of EBPs in routine practice severely limits their public health impact, highlighting the need to understand factors that affect the return on costly investments in EBP implementation. This study aims to (1) characterize trajectories of EBP delivery volume through a reimbursement-driven implementation and (2) examine impacts of system-level policy regulatory activity and state-level mental health services funding on the implementation reimbursement strategy. This study involved secondary data analyses. Psychotherapy administrative claims and regulatory site visit data from the Los Angeles County Department of Mental Health and California state mental health expenditures were extracted from 2010 to 2017. Multilevel regression examined EBP claims volume over time with state expenditures and regulatory compliance as predictors. EBP claims volume trajectories demonstrated a rapid initial increase, followed by a period of decrease, and a small increase in the final year. State mental health expenditures increased across time reflecting increased funding availability. State mental health expenditures and system regulatory compliance were inversely related to EBP claims volume. The impact of reimbursement-driven EBP implementation strategy is sensitive to multiple outer-context determinants. At the system level, commitment to fidelity of implementation regulations resulted in reduced use of the reimbursement strategy. Alternative reimbursement streams not tied to EBPs coupled with an expanded array of reimbursable services also impacted the use of the reimbursement strategy to implement EBPs.https://doi.org/10.1186/s13012-021-01149-

Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

A Short-term Intervention to Improve Emotion-processing Skills in Adolescents with Callous-Unemotional Traits

Thesis (Ph.D.), Psychology - Clinical, Washington State UniversityResearch documents a robust relation between callous-unemotional (CU) traits and impairments in emotion recognition and perspective-taking in youth. However, few evidence-based treatments targeting these specific deficits exist for individuals with CU traits. Treatment for youth with CU traits generally focuses on behavioral functioning (e.g., decreasing delinquency or antisocial behaviors), but these youth often do not respond adequately to standard treatments. Existing interventions may be missing adaptations to the distinct emotional processing deficits associated with CU traits. The current study attempts to address this gap by examining a novel short-term intervention to target emotion processing deficits in adolescents with CU traits. An Emotion-Processing Skills Training (EPST) program was developed to address emotion recognition and perspective-taking deficits. Fifty-six adolescents aged 16 to 18 attending a residential program were randomly assigned to receive the EPST intervention or treatment as usual (TAU) in the residential program. Assessments were conducted at four time points and involved multiple informants (i.e., adolescents, parents, peers, program data, and staff). Path analytic models indicated that participants across both conditions demonstrated improvements in emotion recognition, affective perspective-taking, and self-reported social and externalizing problems from baseline to post-treatment. Unexpectedly, participants also demonstrated significant decrease in CU traits over time. There was little improvement in empathy or prosocial behaviors. Participants in the EPST condition demonstrated better functioning relative to participants in the TAU condition on some assessments. Overall, the EPST intervention was effective at improving affective, social, and behavioral functioning, as well as CU traits among adolescents, and it yielded comparable or greater improvements than TAU. Implications for treatment for adolescents with CU traits are discussed.Washington State University, Psychology - Clinica

Parental ADHD Symptoms and Self-Reports of Positive Parenting

Objective: In 2 studies, we tested whether parental attention-deficit/hyperactivity disorder (ADHD) symptoms are associated with self-reports of more positive parenting, even after accounting for observed positive parenting behaviors. Method: In Study 1, 96 mothers with sons 8 –11 years of age participated; 44% of the boys were diagnosed with ADHD. The majority of mothers and sons were European Caucasian. In Study 2, 48 parents (24 mother–father pairs) with children 6 –12 years of age participated. All children in Study 2 were diagnosed with ADHD, and 75% of the children were boys. More than 90% of the families were Caucasian. In both studies, parents self-reported on their positive parenting, and positive parenting was observed in parent– child interactions. Results: In models including relevant demographic variables, other parental psychopathologies, and both inattentive and hyperactive/impulsive symptoms, parents with higher levels of hyperactive/impulsive symptoms self-reported engaging in significantly more positive parenting behaviors than were observed. Parental inattentive symptoms were not uniquely associated with self-reports of positive parenting. This pattern was found for both mothers and fathers, and across families with and without children diagnosed with ADHD. Conclusions: Results suggest that high levels of parental ADHD symptoms may be associated with over-estimation of positive parenting behaviors. Reasons for the distinction between the types of ADHD symptoms associated with higher self-reports of positive parenting and the clinical implications of the findings are discussed.Arts, Faculty ofPsychology, Department ofNon UBCReviewedFacult

Comprehensive psychosocial screening in a pediatric diabetes clinic

The ISPAD recommends routine, comprehensive psychosocial screening for adolescents with diabetes. However, few clinics have implemented procedures consistent with these guidelines. This study describes the results of a universal, comprehensive psychosocial screening program in an integrated pediatric diabetes clinic located within an academic medical center. Participants included 232 ethnically diverse adolescents with type 1 diabetes (55.5% female; M age = 14.85; 58.5% Hispanic; 20% Black). Adolescents completed screening measures on iPads in the waiting room before their medical visit. The proportion of adolescents screening positive on each psychosocial measure was assessed, and regression analyses evaluated how psychosocial variables accounted for variance in insulin non-adherence and glycemic control (measured by A1c). Psychosocial concerns were common and ranged from 7% of adolescents screening positive for disordered eating and suicide risk to 52% screening positive for low motivation to manage diabetes. A1c and insulin non-adherence were positively correlated with suicide risk, depressive symptoms, anxiety, disordered eating, diabetes stress, blood glucose monitoring stress, family conflict, and total number of elevations, and negatively correlated with intrinsic motivation. Insulin non-adherence, disordered eating, diabetes stress, and family conflict uniquely predicted A1c. Age, motivation, and family conflict uniquely predicted insulin non-adherence. Eighty-three percent of eligible youth completed the screener. Referrals by physicians to the team psychologist increased by 25% after the screening program was implemented. Comprehensive psychosocial screening can be effectively implemented as part of routine pediatric diabetes care and can identify adolescents in need of additional supports

Train-to-Sustain: Predictors of Sustainment in a Large-Scale Implementation of Parent-Child Interaction Therapy.

Sustainment of evidence-based practices is necessary to ensure their public health impact. The current study examined predictors of sustainment of Parent-Child Interaction Therapy (PCIT) within a large-scale system-driven implementation effort in Los Angeles County. Data were drawn from PCIT training data and county administrative claims between January 2013 and March 2018. Participants included 241 therapists from 61 programs. Two sustainment outcomes were examined at the therapist- and program-levels: 1) PCIT claim volume and 2) PCIT claim discontinuation (discontinuation of claims during study period; survival time of claiming in months). Predictors included therapist- and program-level caseload, training, and workforce characteristics. On average, therapists and programs continued claiming to PCIT for 17.7 and 32.3 months, respectively. Across the sustainment outcomes, there were both shared and unshared significant predictors. For therapists, case-mix fit (higher proportions of young child clients with externalizing disorders) and participation in additional PCIT training activities significantly predicted claims volume. Furthermore, additional training activity participation was associated with lower likelihood of therapist PCIT claim discontinuation in the follow-up period. Programs with therapists eligible to be internal trainers were significantly less likely to discontinue PCIT claiming. Findings suggest that PCIT sustainment may be facilitated by implementation strategies including targeted outreach to ensure eligible families in therapist caseloads, facilitating therapist engagement in advanced trainings, and building internal infrastructure through train-the-trainer programs