Making Implementation Last: Understanding the Sustainability of an Evidence-based Treatment

Although advances have been made in facilitating the implementation of evidence-based treatments, little is known about the most effective way to sustain their use over long periods of time. Prior systematic reviews and research have suggested that organizational characteristics and training methods may be strategies that support sustainability, yet this has remained relatively unstudied in the field of behavioral health. The current study examined the sustainability of Parent-Child Interaction Therapy following a statewide implementation trial testing three training methods. Participants included 100 clinicians and 50 administrators from 50 organizations across Pennsylvania. Multi-level path analysis was utilized to examine the role of organizational barriers and training on sustainability. Clinicians and administrators reported high levels of sustainability at 24-months (12-months post-training) in the current study. Several organizational variables, including training exposure and utilization and resources at baseline and following training were associated with greater sustainability. The cascading model training condition was also related to being more likely to sustain the use of Parent-Child Interaction Therapy. Possible mechanism of change, through increased organizational resources, were also identified. Implications for training and the broader field of implementation science are discussed

An Examination of the Consultation Component of a Training Protocol for Parent-Child Interaction Therapy

There is a growing need to train clinicians in evidence-based treatments (EBTs) to increase the accessibility of research-informed treatments in community settings (Herschell, Kolko, Baumann, & Davis, 2010). Multi-component trainings, which commonly include ongoing support, are more effective than one-day workshops, reading treatment manuals, and other brief training methods. The present study examines the effectiveness of one form of ongoing support, consultation, as part of a multi-component training protocol. Thirty-two community-based clinicians were trained in Parent-Child Interaction Therapy (PCIT) as part of a statewide implementation effort, and data were collected on several training (e.g., knowledge) and implementation (e.g., acceptability) outcomes at pre-, mid-, and post-training. Simple and multiple linear regression analyses were conducted to predict post-training knowledge, skill, acceptability, and feasibility, as well as to examine clinician variables that moderate these relations. Consultation call attendance significantly predicted post-training skill. However, the impact of consultation call attendance on skill was qualified by a significant interaction for PCIT caseload. Implications for training guidelines are discussed

The processing and comprehension of wh-questions among second language speakers of German

ABSTRACT Using the self-paced reading paradigm, the present study examines whether highly proficient second language (L2) speakers of German (English first language) use case-marking information during the on-line comprehension of unambiguous wh-extractions, even when task demands do not draw explicit attention to this morphosyntactic feature in German. Results support previous findings, in that both the native and the L2 German speakers exhibited an immediate subject preference in the matrix clause, suggesting they were sensitive to case-marking information. However, only among the native speakers did this subject preference carry over to reading times in the complement clause. The results from the present study are discussed in light of current debates regarding the ability of L2 speakers to attain nativelike processing strategies in their L2. An increasing body of research addresses the question of how second language (L2) speakers process L2 input and the extent to which their processing strategies parallel the strategies employed by native speakers (for two recent reviews, se

Counseling students’ attitudes toward complementary and alternative medicine integration in counseling practice

This study explored counseling students’ attitudes toward beliefs and personal experience with complementary and alternative medicine (CAM) integration in counseling practices. A total of 113 clinical mental health counseling students completed a demographic questionnaire, the CAM use, and the Complementary and Alternative Medicine Beliefs Inventory. Data were analyzed using descriptive statistics, nonparametric Chi-Square testing, Mann–Whitney U test, and logistic regression analysis to determine the prevalence of CAM use, CAM beliefs, and predictive factors of CAM integration. The results indicated differences in ethnicity, gender, and age for CAM use, CAM beliefs, and predictors of attitudes toward CAM integration. Recommendations for counseling practice and education regarding CAM use and community-based health promotion were discussed

East of England Eyecare Workforce Transformation through increasing capacity and capability, integrating advancing practice initiatives and the Ophthalmic Practitioner Training programme (OPT):Phase 1: Final Report

A three phased project aims to address the integration of eyecare workforce development within wider initiatives (across population groups/specialties) and strengthen workforce capability and capacity to deliver eyecare on a whole-system basis across East of England. Phase 1 aimed to 1) build the foundation for growing capability and capability of the whole workforce across different contexts to meet the needs of people with actual/potential eye conditions to optimise existing workforce ‘assets’, while taking a supportive approach to identifying and addressing learning needs and 2) make recommendations for Health Education England (Eastern); Integrated Care Systems (ICSs) and Higher Education Institutes (HEIs) to inform subsequent stages

Evaluating Treatments and Interventions: What Constitutes “Evidence-based” Treatment?

This chapter provides an overview of the evidence-based treatment (EBT) paradigm, beginning with definitional issues, followed by a discussion on use of the iterative process and the importance of strong academic–practice partnerships to inform the development, selection, and implementation of EBTs. The discussion then turns to the importance of attaining, measuring, and sustaining fidelity to the treatment models; and identifying common barriers to sustained EBT use. Drawing from our expertise related to interventions for children and adolescents, a few dissemination/implementation models are highlighted as examples of current efforts to achieve sustained use of EBTs among practitioners, within agencies, and across communities. This involves keeping up to date with the research and integrating the available evidence base with clinical expertise and patient characteristics, including cultural considerations and client preferences for treatment. The chapter concludes with directions for the future, including considerations for practitioners, referring agents, and agency senior leaders to promote, support, and sustain EBTs

Web-Based Training Methods for Behavioral Health Providers: A Systematic Review

There has been an increase in the use of web-based training methods to train behavioral health providers in evidence-based practices. This systematic review focuses solely on the efficacy of web-based training methods for training behavioral health providers. A literature search yielded 45 articles meeting inclusion criteria. Results indicated that the serial instruction training method was the most commonly studied web-based training method. While the current review has several notable limitations, findings indicate that participating in a web-based training may result in greater post-training knowledge and skill, in comparison to baseline scores. Implications and recommendations for future research on web-based training methods are discussed

Strengthening nursing, midwifery and allied health professional leadership in the UK - a realist evaluation

Purpose: This paper aims to share the findings of a realist evaluation study that set out to identify how to strengthen nursing, midwifery and allied health professions (NMAHP) leadership across all health-care contexts in the UK conducted between 2018 and 2019. The collaborative research team were from the Universities of Bangor, Ulster, the University of the West of Scotland and Canterbury Christ Church University. Design/methodology/approach: Realist evaluation and appreciative inquiry were used across three phases of the study. Phase 1 analysed the literature to generate tentative programme theories about what works, tested out in Phase 2 through a national social media Twitter chat and sense-making workshops to help refine the theories in Phase 3. Cross-cutting themes were synthesised into a leadership framework identifying the strategies that work for practitioners in a range of settings and professions based on the context, mechanism and output configuration of realist evaluation. Stakeholders contributed to the ongoing interrogation, analysis and synthesis of project outcomes. Findings: Five guiding lights of leadership, a metaphor for principles, were generated that enable and strengthen leadership across a range of contexts. – “The Light Between Us as interactions in our relationships”, “Seeing People’s Inner Light”, “Kindling the Spark of light and keeping it glowing”, “Lighting up the known and the yet to be known” and “Constellations of connected stars”. Research limitations/implications: This study has illuminated the a-theoretical nature of the relationships between contexts, mechanisms and outcomes in the existing leadership literature. There is more scope to develop the tentative programme theories developed in this study with NMAHP leaders in a variety of different contexts. The outcomes of leadership research mostly focussed on staff outcomes and intermediate outcomes that are then linked to ultimate outcomes in both staff and patients (supplemental). More consideration needs to be given to the impact of leadership on patients, carers and their families. Practical implications: The study has developed additional important resources to enable NMAHP leaders to demonstrate their leadership impact in a range of contexts through the leadership impact self-assessment framework which can be used for 360 feedback in the workplace using the appreciative assessment and reflection tool. Social implications: Whilst policymakers note the increasing importance of leadership in facilitating the culture change needed to support health and care systems to adopt sustainable change at pace, there is still a prevailing focus on traditional approaches to individual leadership development as opposed to collective leadership across teams, services and systems. If this paper fails to understand how to transform leadership policy and education, then it will be impossible to support the workforce to adapt and flex to the increasingly complex contexts they are working in. This will serve to undermine system integration for health and social care if the capacity and capability for transformation are not attended to. Whilst there are ambitious global plans (WHO, 2015) to enable integrated services to be driven by citizen needs, there is still a considerable void in understanding how to authentically engage with people to ensure the transformation is driven by their needs as opposed to what the authors think they need. There is, therefore, a need for systems leaders with the full skillset required to enable integrated services across place-based systems, particularly clinicians who are able to break down barriers and silo working across boundaries through the credibility, leadership and facilitation expertise they provide. Originality/value: The realist evaluation with additional synthesis from key stakeholders has provided new knowledge about the principles of effective NMAHP leadership in health and social care, presented in such a way that facilitates the use of the five guiding lights to inform further practice, education, research and policy development

p53 null Fluorescent Yellow Direct Repeat (FYDR) mice have normal levels of homologous recombination

The tumor suppressor p53 is a transcription factor whose function is critical for maintaining genomic stability in mammalian cells. In response to DNA damage, p53 initiates a signaling cascade that results in cell cycle arrest, DNA repair or, if the damage is severe, programmed cell death. In addition, p53 interacts with repair proteins involved in homologous recombination. Mitotic homologous recombination (HR) plays an essential role in the repair of double-strand breaks (DSBs) and broken replication forks. Loss of function of either p53 or HR leads to an increased risk of cancer. Given the importance of both p53 and HR in maintaining genomic integrity, we analyzed the effect of p53 on HR in vivo using Fluorescent Yellow Direct Repeat (FYDR) mice as well as with the sister chromatid exchange (SCE) assay. FYDR mice carry a direct repeat substrate in which an HR event can yield a fluorescent phenotype. Here, we show that p53 status does not significantly affect spontaneous HR in adult pancreatic cells in vivo or in primary fibroblasts in vitro when assessed using the FYDR substrate and SCEs. In addition, primary fibroblasts from p53 null mice do not show increased susceptibility to DNA damage-induced HR when challenged with mitomycin C. Taken together, the FYDR assay and SCE analysis indicate that, for some tissues and cell types, p53 status does not greatly impact HR.National Institute of Environmental Health Sciences (ES02109)National Cancer Institute (U.S.) (R33CA112151)National Cancer Institute (U.S.) (R01CA79827)United States. Dept. of Energy (DE-FG01-04ER04-21)National Institute of Environmental Health Sciences (T32 ES007020, NIEHS Training Grant in Environmental Toxicology)National Science Foundation (U.S.) (Fellowship