Case Management as a Significant Component of Usual Care Psychotherapy for Youth with Disruptive Behavior Problems

Youth with disruptive behavior problems (DBPs) represent the majority of youth served in usual care (UC) psychotherapy, and are at high risk for maladaptive outcomes. Little is known about UC psychotherapeutic strategies utilized with this population. Researchers and clinicians suggest that case management (CM) is a major activity occurring in usual care. CM includes coordinating care with service providers and individuals, including schools, psychiatrists, and community-based services. This study assesses the prevalence and predictors of clinician use of CM in usual care. Results from this study suggest that CM is frequently used in UC psychotherapy with youth with DBPs. The extent of use of CM in UC may have implications for implementation of evidence-based practices in usual care psychotherapy

'Usual Care' psychotherapy outcomes associated with therapist use of case management in the treatment of youths who have disruptive behavior problems

Children with disruptive behavior problems (DBPs) represent the majority of youth patients in community- based, usual care (UC) psychotherapy, and are at high risk for maladaptive adolescent and adult outcomes (Copeland et al., 2007; Earls, 1994a). Improved knowledge about effective treatments for this population is essential. Although there is movement towards implementing evidence- based practices (EBPs) into UC, there are numerous barriers. Among these is a lack of knowledge regarding psychotherapeutic processes in usual care. Researchers and practitioners suggest that case management (CM) is a widely-used, essential, and effective component of treatment for this population (Burns et al., 1996; Hoagwood et al., 2001; Garland et al., 2010). CM includes coordinating care with psychiatrists and school professionals, child protective services, and referring families to community-based resources (Ziguras & Stewart, 2000). The current study examines the association between intensity of therapist use of CM and six outcomes : (1) youth symptom severity, (2 &3) family functioning (parent and youth reports), (4) attendance, and (5 & 6) satisfaction (parent and youth reports). This study also examines potential moderator effects of therapist discipline and therapist experience on the relationship between CM and outcomes. Analyses were conducted using Hierarchical Linear Modeling (HLM) to account for the nested structure of the data. Results suggest that while there was no first-order effect of CM on outcomes, therapist (N=77) variables significantly moderated the relationships between CM and outcomes. For Social Workers and therapists with more experience, higher levels of CM intensity were associated with a greater decrease in youth symptomatology (N=165). For Psychologists, more intensive use of CM was associated with greater improved family functioning. This study suggests that CM can positively affect youth outcomes in the context of UC when utilized effectively. This study is a first step towards examining the role of CM in community-based psychotherapy, and its contribution to outcomes for youth with DBPs. Results also have implications for future efforts to implement EBPs in usual care psychotherap

Review of the Management of Pediatric Post-Concussion Syndrome—a Multi-Disciplinary, Individualized Approach

Purpose of reviewPost-concussion syndrome (PCS), when the patient's concussion symptoms last longer than 4-6 weeks, affects 10-30% of concussion patients. PCS presents a significant source of morbidity to patients and a management challenge to providers. In this review, we present the current evidence and best management approaches for pediatric PCS.Recent findingsThere is limited high-quality evidence in pediatric PCS. There is some evidence supporting pharmaceutical management of post-traumatic headaches, cognitive symptoms, and emotional symptoms. Vestibular-ocular dysfunction should be evaluated and managed appropriately. Neuropsychological recovery is expected, but requires appropriate attention to Return to Learn. Emotional symptoms are common in PCS and the evidence supports treatment with cognitive behavioral therapy. PCS presents a unique therapeutic challenge affecting multiple domains for patients-physical, sleep, cognitive, and emotional. Successful management of PCS requires a multi-disciplinary and individualized approach. There remains a significant need for further research, specifically looking into the outcomes and effective interventions in pediatric PCS

Factors Associated with Use of Evidence-Based Practice Strategies in Usual Care Youth Psychotherapy

The purpose of this study was to gain an understanding of how therapists providing usual care (UC) psychotherapy are using elements of treatment common to evidence-based practices (EBPs) for children with disruptive behavior disorders (DBPs) and to identify client and therapist characteristics that may be associated with EBP strategies directed toward children and those directed to their caregivers. Results indicate that certain child, family, and therapist characteristics are associated with use of EBP strategies; however, much of the variability in practice was not explained by the variables examined. These findings highlight the complexity of UC psychotherapy and provide directions for future research on implementation of EBPs in UC

Therapist, Parent, and Youth Perspectives of Treatment Barriers to Family-Focused Community Outpatient Mental Health Services

This exploratory qualitative study describes treatment barriers to receiving family-focused child mental health services for youths with disruptive behavior problems from multiple perspectives. Data were collected during a series of focus groups and interviews, including: 4 therapist focus groups, 3 parent focus groups, and 10 youth semi-structured interviews. Therapist, parent, and youth stakeholder participants discussed perceived barriers to effective treatment, the problems with current child outpatient therapy, and desired changes (i.e., policy, intervention, etc.) to improve mental health services. Results indicate similar themes around treatment barriers and dissatisfaction with services within and across multiple stakeholder groups, including inadequate support and lack of family involvement; however, parents and therapists, in particular, identified different contributing factors to these barriers. Overall, stakeholders reported much frustration and dissatisfaction with current community-based outpatient child therapy services. Study findings can inform service provision, intervention development, and future research