'I Just Stopped Going': A Mixed Methods Investigation Into Types of Therapy Dropout in Adolescents With Depression

What does it mean to ‘drop out’ of therapy? Many definitions of ‘dropout’ have been proposed, but the most widely accepted is the client ending treatment without agreement of their therapist. However, this is in some ways an external criterion that does not take into account the client’s experience of therapy, or reasons for ending it prematurely. This study aimed to identify whether there were more meaningful categories of dropout than the existing dropout definition, and to test whether this refined categorization of dropout was associated with clinical outcomes. This mixed-methods study used a subset of data from the IMPACT trial, which investigated psychological therapies for adolescent depression. Adolescents were randomly allocated to a treatment arm (Brief Psychosocial Intervention; Cognitive-Behavioral Therapy; Short-Term Psychoanalytic Psychotherapy). The sample for this study comprised 99 adolescents, aged 11–17 years. Thirty-two were classified as having dropped out of treatment and participated in post-therapy qualitative interviews about their experiences of therapy. For 26 dropout cases, the therapist was also interviewed. Sixty-seven cases classified as having completed treatment were included to compare their outcomes to dropout cases. Interview data for dropout cases were analyzed using ideal type analysis. Three types of dropout were constructed: ‘dissatisfied’ dropout, ‘got-what-they-needed’ dropout, and ‘troubled’ dropout. ‘Dissatisfied’ dropouts reported stopping therapy because they did not find it helpful. ‘Got-what-they-needed’ dropouts reported stopping therapy because they felt they had benefitted from therapy. ‘Troubled’ dropouts reported stopping therapy because of a lack of stability in their lives. The findings indicate the importance of including the perspective of clients in definitions of drop out, as otherwise there is a risk that the heterogeneity of ‘dropout’ cases may mask more meaningful distinctions. Clinicians should be aware of the range of issues experienced by adolescents in treatment that lead to disengagement. Our typology of dropout may provide a framework for clinical decision-making in managing different types of disengagement from treatment

Differential negative reinforcement of other behavior to increase compliance with wearing an anti-strip suit

Using a changing-criterion design, we replicated and extended a study (Cook, Rapp, & Schulze, 2015) on differential negative reinforcement of other behavior (DNRO). More specifically, educational assistants implemented DNRO to teach a 12-year-old boy with autism spectrum disorder to comply with wearing an anti-strip suit to prevent inappropriate fecal behavior in a school setting. The duration for which the participant wore the suit systematically increased from 2 s at the start of treatment to the entire duration of the school day at the termination of the study. Moreover, these effects were generalized to a new school with novel staff and persisted for more than a year. These findings replicate prior research on DNRO and further support the use of the intervention to increase compliance with wearing protective items, or medical devices, in practical settings

Reprint of “The Single-Case Reporting Guideline In BEhavioural interventions (SCRIBE) 2016: explanation and elaboration”

There is substantial evidence that research studies reported in the scientific literature do not provide adequate information so that readers know exactly what was done and what was found. This problem has been addressed by the development of reporting guidelines which tell authors what should be reported and how it should be described. Many reporting guidelines are now available for different types of research designs. There is no such guideline for one type of research design commonly used in the behavioral sciences, the single-case experimental design (SCED). The present study addressed this gap. This report describes the Single-Case Reporting guideline In BEhavioural interventions (SCRIBE) 2016, which is a set of 26 items that authors need to address when writing about SCED research for publication in a scientific journal. Each item is described, a rationale for its inclusion is provided, and examples of adequate reporting taken from the literature are quoted. It is recommended that the SCRIBE 2016 is used by authors preparing manuscripts describing SCED research for publication, as well as journal reviewers and editors who are evaluating such manuscripts.Published versio

REACHING PEOPLE IN NEED OF MENTAL HEALTH SERVICES THROUGH NOVEL MODELS OF INTERVENTION DELIVERY

The treatment gap refers to the difference in the proportion of people who have disorders and the proportion of those individuals who receive treatment. In developing and developed countries, the gap is enormous, i.e., most individuals in need of mental health services receive no treatment. Among the many barriers is the dominant model of delivering psychosocial interventions. That model includes one-to-one, in-person treatment, with a trained mental health professional, provided in clinical setting (e.g., clinic, private practice office, health-care facility). That model greatly limits the scale and reach of psychosocial interventions. The article discusses many novel models of delivering interventions that permit scaling treatment to reach people who are not likely to receiveservices. Four models (task shifting, best-buy, disruptive interventions, and Entertainment Education) are illustrated. These and other models are readily available, most have evidence in their behalf, but are still not sufficiently exploited to close the treatment gap. The article argues for the need for multiple models to optimize reaching the many diverse groups in need of care

Hospital cost inflation : economic approaches for policy analysis.

Thesis. 1979. M.S.--Massachusetts Institute of Technology. Alfred P. Sloan School of Management.MICROFICHE COPY AVAILABLE IN ARCHIVES AND DEWEY.Includes bibliographical references.M.S

LLEGANDO A LAS PERSONAS QUE NECESITAN SERVICIOS DE SALUD MENTAL A TRAVÉS DE NOVEDOSOS MODELOS DE PRESTACIÓN DE INTERVENCIONES

La brecha de tratamiento se refiere a la diferencia en la proporción de personas que tienen trastornos y la proporción de personas que reciben tratamiento. En los países desarrollados y en desarrollo, la brecha es enorme; es decir, la mayoría de las personas que necesitan servicios de salud mental no recibe tratamiento. Entre las muchas barreras, se encuentra el modelo dominante de realizar intervenciones psicosociales. Ese modelo incluye tratamiento individualizado en persona, con un profesional de salud mental capacitado, proporcionado en un entorno clínico (por ejemplo, clínica, consultorio privado, centro de atención médica). Ese modelo limita en gran medida la escala y el alcance de las intervenciones psicosociales. El artículo analiza muchos modelos novedosos de prestación de intervenciones que permiten ampliar el tratamiento para llegar a las personas que probablemente no recibirán servicios. Se ilustran cuatro modelos (cambio de tareas, mejor compra, intervenciones disruptivas y educación en entretenimiento). Estos y otros modelos están fácilmente disponibles, la mayoría tiene evidencia a su favor, pero aún no se explotan lo suficiente como para cerrar la brecha de tratamiento. El artículo sostiene la necesidad de múltiples modelos para optimizar llegar a los diversos grupos que necesitan atención

Feasibility and potential effectiveness of an intensive trauma-focused treatment programme for families with PTSD and mild intellectual disability

Background: Persons with mild intellectual disabilities or borderline intellectual functioning (MID-BIF; IQ 50–85) have a higher risk of being exposed to traumatic events and developing posttraumatic stress disorder (PTSD). EMDR therapy has shown to be applicable, safe and potentially effective for the treatment of PTSD in individuals with MID-BIF. However, in traumatized multi-problem families with MID-BIF and (impending) out of home placement of children, standard PTSD treatment in an outpatient setting may not be appropriate. Objective: To evaluate the feasibility and potential effectiveness of KINGS-ID, a six-week clinical trauma-focused treatment programme consisting of intensive EMDR therapy with parents and children, and parental skills training followed by two weeks of parent support at home. Method: Six families (nine parents of whom six had MID-BIF) and 10 children (all having MID-BIF) participated in the KINGS-ID programme. Seven parents and seven children had PTSD. Data were collected within a single case study design. For each family member data were collected during baseline (three measurements), treatment (seven weekly measurements), posttreatment (three measurements) and at follow-up (three measurements). Results: None of the family members dropped out. Within the first two treatment weeks all but one child and one parent no longer met PTSD symptom criteria. In both children and parents, trauma-related symptoms and daily life impairment significantly decreased following treatment and in parents a significant decrease in symptoms of general psychopathology and parental stress was found. Results were maintained at six-month follow-up. Conclusions: The findings of the current study are promising given that the treatment programme seems to offer new perspectives for traumatized multi-problem families with MID-BIF