Effect of Clinician Training in the Modular Approach to Therapy for Children vs Usual Care on Clinical Outcomes and Use of Empirically Supported Treatments: A Randomized Clinical Trial

IMPORTANCE The Modular Approach to Therapy for Children (MATCH) was developed to address the comorbidities common among clinically referred youth, with beneficial outcomes shown in 2 US randomized clinical trials, where it outperformed both usual clinical care and single disorder–specific treatments. OBJECTIVE To determine whether MATCH training of clinicians would result in more use of empirically supported treatment (EST) and better clinical outcomes than usual care (UC) in the publicly funded, multidisciplinary context of New Zealand. DESIGN, SETTING, AND PARTICIPANTS This multisite, single-blind, computer-randomized clinical effectiveness trial compared MATCH with UC in child and adolescent mental health services in 5 regions of New Zealand. Recruitment occurred from March 2014 to July 2015, and a 3-month follow-up assessment was completed by May 2016. Clinicians at participating child and adolescent mental health services were randomized (1:1) to undertake training in MATCH or to deliver UC, and young people with anxiety, depression, trauma-related symptoms, or disruptive behavior seeking treatment at child and adolescent mental health services were randomized (1:1) to receive MATCH or UC. Participants and research assistants were blind to allocation. Data analysis was performed from April 2016 to July 2017. INTERVENTIONS MATCH comprises EST components for flexible management of common mental health problems. UC includes case management and psychological therapies. Both can include pharmacotherapy. MAIN OUTCOMES AND MEASURES There were 3 primary outcomes: trajectory of change of clinical severity, as measured by weekly ratings on the Brief Problem Monitor (BPM); fidelity to EST content, as measured by audio recordings of therapy sessions coded using the Therapy Integrity in Evidence Based Interventions: Observational Coding System; and efficiency of service delivery, as measured by duration of therapy (days) and clinician time (minutes). RESULTS The study included 65 clinicians (mean age, 38.7 years; range, 23.0-64.0 years; 54 female [83%]; MATCH, 32 clinicians; UC, 33 clinicians) and 206 young people (mean age, 11.2 years; range 7.0-14.0 years; 122 female [61%]; MATCH, 102 patients; UC, 104 patients). For the BPM total ratings for parents, there was a mean (SE) slope of –1.04 (0.14) (1-year change, −6.12) in the MATCH group vs –1.04 (0.10) (1-year change, −6.17) in the UC group (effect size, 0.00; 95% CI, −0.27 to 0.28; P = .96). For the BPM total for youths, the mean (SE) slope was –0.74 (0.15) (1-year change, −4.35) in the MATCH group vs –0.73 (0.10) (1-year change, −4.32) in the UC group (effect size, −0.02; 95% CI, −0.30 to 0.26; P = .97). Primary analyses (intention-to-treat) showed no difference in clinical outcomes or efficiency despite significantly higher fidelity to EST content in the MATCH group (58 coded sessions; mean [SD], 80.0% [20.0%]) than the UC group (51 coded sessions; mean [SD], 57.0% [32.0%]; F(1,108) = 23.0; P  CONCLUSIONS AND RELEVANCE MATCH significantly increased adherence to EST practices but did not improve outcomes or efficiency. The nonsuperiority of MATCH may be attributable to high levels of EST use in UC in New Zealand. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Identifier: ACTRN1261400029762

Weekly assessment of worry: an adaptation of the Penn State Worry Questionnaire for monitoring changes during treatment

An adaptation of the Penn State Worry Questionnaire (PSWQ) [Meyer, T. J., Miller, M. L., Metzger, R. L. and Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487-495.] for weekly assessment of worry was evaluated in a brief treatment study. Cognitive restructuring techniques were taught to 28 nonclinical high-worriers, 14 of whom served as a control group in a lagged waiting-list design. Results showed that the Penn State Worry Questionnaire-Past Week (PSWQ-PW) was highly reliable and substantially valid in the assessment of both (a) weekly status of worry and (b) treatment-related changes in worry: average Cronbach's alpha was 0.91; average convergent correlation with a past-week adaptation of the Worry Domains Questionnaire [Tallis, F., Eysenck, M. W. and Mathews, A. (1992). A questionnaire for the measurement of nonpathological worry. Personality and Individual Differences, 13, 161-168.] was 0.63 and pre-post improvement on PSWQ-PW showed a 0.71 correlation with the Questionnaire of Changes in Experiencing and Behavior [Zielke, M. and Kopf-Mehnert, C. (1978). Veränderungsfragebogen des Erlebens und Verhaltens. Weinheim, Germany: Beltz Test Gesellschaft.]. It is concluded that the PSWQ-PW is a useful instrument for monitoring pathological worry in experimental and applied settings

Diesseits und jenseits des Hirsches : Theorie und Praxis einer Poesiemaschine

Die vorliegende Arbeit beschreibt den ein Jahr lang andauernden Prozess der Entwicklung meiner eigenen Poesiemaschine. Buchrückentext: Wer ist der Hirsch? Und was hat er mit dem Buch zu tun? Der Band dokumentiert auf spielerische Weise den Entstehungsprozess einer außergewöhnlich leistungsfähigen Poesiemaschine. Den drei Versionen dieser Poesiemaschine werden die bildhaften Namen Wurm, Hähnchen und Hirsch gegeben. Inspiriert von Hans Magnus Enzensbergers Einladung zu einem Poesieautomaten wagt sich der Autor «in das Labyrinth» hinein. Nach dem Vorbild der französischen Literaturgruppe Oulipo werden zunächst die Anforderungen an eine Poesiemaschine in formelle, akustische, syntaktische, semantische und kreative Einschränkungen unterteilt. Die Modellierung der syntaktischen und kreativen Aspekte orientiert sich insbesondere an der Installation Poetry Machine des renommierten Medienkünstlers David Link. Neuartig beim Hirsch ist die Verwirklichung phonetischer Algorithmen, die Gedichte mit komplexen Reimen und metrischer Regulierung ermöglichen. Abschließend wirft der Autor einen Blick in die Zukunft. Das Ergebnis stellt eine Goldgrube an Einsichten und Ideen dar für Poesiemaschinen-Entwickler der nächsten Generation. Inhalt: Aus dem Inhalt: «Jenseits der Berechenbarkeit» - Was muss ein Poesie-Erzeuger können? - Gedichtgerüstbau anhand der GGT-Grammatik - Überraschungseffekt - Poesiemaschine Poetry Machine - Carnegie Mellons phonetisches Wörterbuch - WordNet - eine lexikalische Datenbank - POS-Tagger - Syntaktische Formeln mit dem manuellen Tagger - Blocking - Balancing - Phonetischer Beweis - Jenseits des Hirsches (Zukunft der Computerpoesie) - Computing with Words - Stephen Thalers Creativity Machine

Desarrollo de una versión de 30 items de la Revised Child Anxiety and Depression Scale

This is to present the factor structure and psychometric properties of a Spanish reduced 30-item version of the Revised Child Anxiety and Depression Scale (RCADS; Chorpita, Yim, Moffi tt, Umemoto y Francis, 2000) applied to a sample of children and adolescents. This abbreviated form (RCADS-30) consists of six 5-item subscales assessing the same anxiety and depression syndromes as the original scale, that is, panic disorder, social phobia, separation anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and major depressive disorder. Data provide support for factorial validity, internal consistency, normative data, and convergent and discriminant validity of the RCADS-30. Psychometric properties and elevated correlations between both scales suggest that the abbreviated form is similar to the Spanish full version. The RCADS-30 is considered an appropriate multidimensional instrument for research as well as clinical settings.En el presente estudio presentamos la estructura factorial y las propiedades psicométricas de una versión española reducida de 30 items de la Revised Child Anxiety and Depression Scale (RCADS; Chorpita, Yim, Moffi tt, Umemoto y Francis, 2000), basado en una muestra de niños y adolescentes. Esta forma abreviada (RCADS-30) consiste en seis subescalas de 5 items que miden los mismos síndromes de ansiedad y depresión que la escala original (i.e., trastorno de pánico, fobia social, trastorno de ansiedad de separación, trastorno de ansiedad generalizada, trastorno obsesivo-compulsivo, y trastorno depresivo mayor). Los resultados apoyan la validez factorial, consistencia interna, datos normativos, y validez convergente y discriminante de la RCADS-30. Las propiedades psicométricas y las elevadas correlaciones entre ambas escalas sugieren que la forma abreviada es similar a la forma completa. Sugerimos que la RCADS-30 es un instrumento multidimensional apropiado tanto para situaciones de investigación como clínicas

Validation Study of Tripartite Model of Anxiety and Depression in Children and Adolescents: Clinical Sample in Korea

Although the currently available literature has provided some empirical support for a tripartite model of child and adolescent anxiety and depression, one of the limitations of these studies was that they have been conducted in America, primarily with Caucasians. In order to make this model more applicable to diverse ethnic and cultural groups, this study used a tripartite model for child and adolescent anxiety and depression in Korea, using confirmatory factor analysis with logically selected items from the Revised Children's Manifest Anxiety Scale (RCMAS), as well as the Children's Depression Inventory (CDI). The results indicated that the model fit of a three-factor model was superior to one- and two-factor models. In addition, the findings of discriminant analysis demonstrated that the correct classification rate with three factors of the tripartite model was superior to the classification rate achievable using CDI and RCMAS. In a departure from Clark and Watson's hypothesis, however, the correlations of three factors were significantly higher than had been expected. The results are discussed on the basis of cultural background

A Psychometric Analysis of the Revised Child Anxiety and Depression Scale—Parent Version in a Clinical Sample

The Revised Child Anxiety and Depression Scale—Parent Version (RCADS-P) is a 47-item parent-report questionnaire of youth anxiety and depression, with scales corresponding to the DSM-IV categories of Separation Anxiety Disorder, Social Phobia, Generalized Anxiety Disorder (GAD), Panic Disorder, Obsessive-Compulsive Disorder, and Major Depressive Disorder (MDD). The RCADS-P is currently the only parent-report questionnaire that concurrently assesses youth symptomatology of individual anxiety disorders as well as depression in accordance with DSM-IV nosology. The present study examined the psychometric properties of the RCADS-P in a large (N = 490), clinic-referred sample of youths. The RCADS-P demonstrated favorable psychometric properties, including high internal consistency, convergent/divergent validity, as well as strong discriminant validity—evidencing an ability to discriminate between anxiety and depressive disorders, as well as between the targeted anxiety disorders. Support for the DSM-related six-factor RCADS-P structure was also evidenced. This structure demonstrated superior fit to a recently suggested alternative to the DSM-IV classification of anxiety and affective disorders—namely, the MDD/GAD “distress” factor

The organizational social context of mental health services and clinician attitudes toward evidence-based practice: a United States national study.

UnlabelledABSTBACKGROUND: Evidence-based practices have not been routinely adopted in community mental health organizations despite the support of scientific evidence and in some cases even legislative or regulatory action. We examined the association of clinician attitudes toward evidence-based practice with organizational culture, climate, and other characteristics in a nationally representative sample of mental health organizations in the United States.MethodsIn-person, group-administered surveys were conducted with a sample of 1,112 mental health service providers in a nationwide sample of 100 mental health service institutions in 26 states in the United States. The study examines these associations with a two-level Hierarchical Linear Modeling (HLM) analysis of responses to the Evidence-Based Practice Attitude Scale (EBPAS) at the individual clinician level as a function of the Organizational Social Context (OSC) measure at the organizational level, controlling for other organization and clinician characteristics.ResultsWe found that more proficient organizational cultures and more engaged and less stressful organizational climates were associated with positive clinician attitudes toward adopting evidence-based practice.ConclusionsThe findings suggest that organizational intervention strategies for improving the organizational social context of mental health services may contribute to the success of evidence-based practice dissemination and implementation efforts by influencing clinician attitudes

A Framework for Measurement Feedback to Improve Decision-Making in Mental Health

The authors present a multi-level framework for conceptualizing and designing measurement systems to improve decision-making in the treatment and prevention of child and adolescent mental health problems as well as the promotion of well-being. Also included is a description of the recommended drivers of the development and refinement of these measurement systems and the importance of the architecture upon which these measurement systems are built. The authors conclude with a set of recommendations for the next steps for the field

Emotional reasoning and anxiety sensitivity: associations with social anxiety disorder in childhood

Background Two specific cognitive constructs that have been implicated in the development and maintenance of anxiety symptoms are anxiety sensitivity and emotional reasoning, both of which relate to the experience and meaning of physical symptoms of arousal or anxiety. The interpretation of physical symptoms has been particularly implicated in theories of social anxiety disorder, where internal physical symptoms are hypothesized to influence the individual's appraisals of the self as a social object. Method The current study compared 75 children on measures of anxiety sensitivity and emotional reasoning: 25 with social anxiety disorder, 25 with other anxiety disorders, and 25 nonanxious children (aged 7–12 years). Results Children with social anxiety disorder reported higher levels of anxiety sensitivity and were more likely than both other groups to view ambiguous situations as anxiety provoking, whether physical information was present or not. There were no group differences in the extent to which physical information altered children's interpretation of hypothetical scenarios. Limitations This study is the first to investigate emotional reasoning in clinically anxious children and therefore replication is needed. In addition, those in both anxious groups commonly had comorbid conditions and, consequently, specific conclusions about social anxiety disorder need to be treated with caution. Conclusion The findings highlight cognitive characteristics that may be particularly pertinent in the context of social anxiety disorder in childhood and which may be potential targets for treatment. Furthermore, the findings suggest that strategies to modify these particular cognitive constructs may not be necessary in treatments of some other childhood anxiety disorders

Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal.

Using outpatients with anxiety and mood disorders (N = 350), Ihe authors tested several models of the structural relationships of dimensions of key features of selected emotional disorders and dimensions of the tripartite model of anxiety and depression. Results supported the discriminant validity of the 5 symptom domains examined (mood disorders; generalized anxiety disorder, GAD; panic disorder; obsessive-compulsive disorder; social phobia). Of various structural models evaluated, the best fitting involved a structure consistent with the tripartite model (e.g., the higher order factors, negative affect and positive affect, influenced emotional disorder factors in the expected manner). The latent factor, GAD, influenced the latent factor, autonomic arousal, in a direction consistent with recent laboratory findings (autonomic suppression). Findings are discussed in the context of the growing literature on higher order trait dimensions (e.g., negative affect) that may be of considerable importance to the understanding of the pathogenesis, course, and co-occurrence of emotional disorders. Over the past few decades, the number of diagnostic categories has increased markedly with each edition of the major classification systems for mental disorders (e.g., the Diagnostic an