Opening the black box: Presenting a model for evaluating organizational-level interventions

Organizational-level occupational health interventions are often recommended when improvements in working conditions, employee health, and well-being are sought within organizations. Research has revealed that these interventions result in inconsistent effects despite being based on theoretical frameworks. This inconsistency indicates that intervention studies need to be designed to examine directly how and why such interventions bring about change and why they sometimes fail. We argue that intervention studies should include a process evaluation that includes a close examination of the psychological and organizational mechanisms that hinder and facilitate desired intervention outcomes. By drawing on existing intervention literature we present an evidence-based model containing three levels of elements that appear to be crucial in process evaluation. We describe how this model may be applied and developed in future research to identify better the mechanisms that link intervention processes to intervention outcomes.     

Mediators of behavior change in two tailored physical activity interventions for adolescent girls

ObjectivesIt has been suggested that the lack of knowledge regarding the mechanisms responsible for behavior change may be responsible for the low levels of effectiveness in physical activity interventions among youth. While it is common for physical activity interventions to cite a theoretical framework, few test the validity of their constructs using an established mediation analysis technique. The purpose of this study was to identify mediators of physical activity behavior change in two tailored interventions for adolescent girls.DesignThis study involved an experimental design.MethodsParticipants (N=161) were randomly allocated to a control (CON) group, an intervention based on the Health Promotion (HP) Model or an intervention developed from the HP Model that included two processes from the Transtheoretical Model (THP). Both interventions included school-based education sessions, individual counseling sessions, and two physical activity sessions completed with the participants' mothers. Measures were assessed prior to the intervention, at post-intervention and at a 6-month follow-up. The following constructs were included in the mediation analyses: perceived benefits, perceived barriers, self-efficacy, exposure to models, social support, interpersonal norms, planning, stimulus control, and counterconditioning.ResultsPerceived benefits, perceived barriers, self-efficacy, and commitment to planning satisfied the criteria for mediation in the THP intervention. Self-efficacy and commitment to planning were identified as mediators in the HP intervention.ConclusionThe results of this study provide evidence that both interventions were successful in increasing physical activity through changes in the theoretical constructs.     

Primary and secondary effects of parenting and stress management interventions for parents of children with developmental disabilities: a meta-analysis

A meta-analysis of the group intervention research for parents of children with developmental disabilities was conducted in order to characterize the efficacy of treatments in reducing depressive symptoms and other forms of psychological distress associated with stress in parents of children with developmental disabilities. An extensive search led to the identification of 17 studies which were divided into three categories for comparative purposes: parenting education studies usually based on behavioral parent training, coping skills education studies based primarily on cognitive behavioral training, and studies that combined these methods along with other support services. Studies were rated for the quality of the research designs and of the reports. Consistent positive benefits were found in the form of reductions in parents' distress, and these effects were comparable to those reported in other syntheses of parenting interventions for parents of children without disabilities. The studies were evaluated in order to assess whether or not they met standards for established evidence-based practices. On the basis of the quality and number of the randomized trials, we present evidence to support the claim that there are established evidence-based interventions for reducing psychological distress at least in middle-class mothers in the short term. The interventions for fathers are promising as are the data on somewhat longer-term effects. The need for replications with a more diverse group of parents and longer-term follow-up were discussed. Multiple component interventions addressing both parent well-being and behavioral parent training were significantly more effective than either behavioral parent training or cognitive behavioral training along.     

A stage-matched intervention for exercise behavior change based on the transtheoretical model

The effectiveness of a stage-matched intervention for enhancing exercise behavior was investigated with related Transtheoretical Model constructs among young Korean adults. 265 university students (147 men, 118 women; M age=24.1 yr., SD=3.5) enrolled in Seoul National University of Technology voluntarily participated in an 8-wk. intervention study. In order to measure exercise behavior and its related psychological constructs, the Stages of Readiness for Exercise Behavior Scale, Decision Balance Scale for Exercise, Exercise Self-efficacy Scale, Processes of Change Scale, and Leisure Time Exercise Questionnaire were used. Results indicated that the participants' exercise readiness was significantly changed in a positive way after the 8-wk. intervention. There was a significant main effect of testing time and an interaction between testing time and exercise readiness stage at baseline. There were significant interactions between testing times and groups for all Transtheoretical Model measures, implying that the stage-matched intervention can be an effective tool for increasing exercise readiness and related psychological variables. The present study provides a starting point for stage-matched interventions aimed at increasing exercise levels, and a baseline level from which to evaluate interventions.     

A complex dynamic systems approach to lasting positive change: The Synergistic Change Model

This paper argues that psychological and social functioning is fundamentally complex, and that this complexity is critical to understanding how lasting positive changes can be achieved. Principles from complex systems theory are integrated into an empirical positive psychological framework to propose a domain-based systems model of positive change called the Synergistic Change Model. This model proposes that enduring positive change depends on the formation of mutually supportive interactions across multiple domains of psychological and social functioning. The paper uses the model to explore three types of response to intervention – relapse, spill-over, and synergy – which have been supported in the existing positive psychology literature. Three practical intervention strategies arising from the model are outlined to inform the design of future positive interventions. The model challenges reductionistic approaches to positive change and offers several approaches to embrace the complexities of lasting positive change in future theory and research.     

(Inter)personal Computing: The Role of the Therapeutic Relationship in E-mental Health

E-mental health technologies are rapidly expanding the reach of psychological interventions around the globe. There is a growing evidence base supporting the potential benefits of these new technologies for psychological and behavioural health. Most of this evidence to date has focused on evaluating the feasibility and outcomes from such interventions, whilst limited research has begun to explore the change processes associated with their impact. In traditional psychological therapies the quality of common factors, including the therapeutic relationship, are widely held to be important for engagement and outcomes. E-mental health interventions present a challenge to the importance of these factors, as therapeutic interactions are typically remote, limited, or even absent in the case of fully automated e-mental health programmes. This paper explores the role of the therapeutic relationship in e-mental health. Where measured, it appears that the relationship is fairly robust to distance and limited contact, but may be less intimately associated with therapy outcomes than in traditional therapies. Where the intervention comprises little or no therapeutic contact, we explore how some of the variance in engagement and outcomes may still be accounted for by common and relational factors offered through a supportive frame or embedded within the technologies themselves. Implications for theory, research and practice are presented.     

Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions

Assessing treatment fidelity is a core methodological consideration in the study of treatment outcome; it influences both the degree to which changes can be attributed to the intervention and the ability to replicate and disseminate the intervention. Efforts to increase access to evidence-based psychological treatments are receiving unprecedented support; but pressures exist to adapt treatments to service settings, running the risk of compromising fidelity. However, little evidence is available to inform the necessary conditions for the transportation of interventions to service provision settings, and the degree to which fidelity is even evaluated or emphasized in dissemination and implementation programs varies dramatically. Moreover, adaptation is associated with several benefits for dissemination efforts and may address relevant barriers to adoption. A particularly promising strategy for maximizing the benefits of both fidelity and adaptation is the use of transdiagnostic interventions. Such treatments allow for greater flexibility of the pacing and content of treatment, while still providing structure to facilitate testing and replication. Preliminary evidence supports the efficacy of this strategy, which may be particularly conducive to dissemination into service provision settings. At this time, further research is needed to evaluate the relationships among fidelity, adaptation, and outcome, and to determine the potential for transdiagnostic treatments to facilitate dissemination.     

Toward Evidence-Based Practice with Domestic Violence Perpetrators

This review examines the policy and practice of interventions with male perpetrators of domestic violence in light of the widely accepted principles of evidence-based practice. Thus far, these policies and practices have enjoyed immunity from the external, empirical accountability available through implementing the findings from evaluations research and other empirical practice analyses. This immunity is supported by a policy framework where, for example, the state certifying agencies may presumptively forbid methods of intervention, with no obligation to empirically assess their efficacy or safety, that contradict the approved model. Based on the review of findings from both explanatory research and interventions research, evidence-based recommendations for policy and program change are proposed.     

Acceptance and commitment therapy (ACT) for people with dementia experiencing psychological distress: A hermeneutic single-case efficacy design (HSCED) series

Introduction

People with dementia have a high prevalence of psychological distress but are underserved with evidence-based psychological interventions. To promote choice and improve clinical outcomes, there is a necessity to test different psychological intervention options for this population.

Purpose

This study aimed to investigate the effectiveness and acceptability of acceptance and commitment therapy (ACT) for people with dementia, considering carer-supported, remote delivery and necessary therapy adaptations.

Methods

A hermeneutic single-case efficacy design series was used to analyse the therapy process and change for three clients with dementia and psychological distress. A matrix of quantitative and qualitative data was collated (“rich case records”) and subject to critical analyses by three independent psychotherapy experts (“judges”) who identified change processes and determined the outcome for each client.

Results

Adjudication concluded that one client made positive changes, specifically reliable reductions in psychological distress, which were largely attributable to ACT. Two clients remained unchanged.

Discussion/Conclusion

Where change was achieved, the ACT-specific processes of values, committed action and acceptance, in combination with non-specific therapy factors, including a strong client–carer relationship, existing client interests and individualised therapy adaptations, were facilitative. Hence, ACT may be a feasible and effective vehicle for therapeutic change by helping carers to better meet the needs of their loved ones. Future research to optimise ACT delivery in this population may be beneficial. Furthermore, the assessment of carer factors (e.g., their psychological flexibility and the client–carer relationship) may strengthen the evidence base for systemic ACT use.     

Mindfulness-Based Approaches with Children and Adolescents: A Preliminary Review of Current Research in an Emergent Field

Interest in applications of mindfulness-based approaches with adults has grown rapidly in recent times, and there is an expanding research base that suggests these are efficacious approaches to promoting psychological health and well-being. Interest has spread to applications of mindfulness-based approaches with children and adolescents, yet the research is still in its infancy. I aim to provide a preliminary review of the current research base of mindfulness-based approaches with children and adolescents, focusing on MBSR/MBCT models, which place the regular practice of mindfulness meditation at the core of the intervention. Overall, the current research base provides support for the feasibility of mindfulness-based interventions with children and adolescents, however there is no generalized empirical evidence of the efficacy of these interventions. For the field to advance, I suggest that research needs to shift away from feasibility studies towards large, well-designed studies with robust methodologies, and adopt standardized formats for interventions, allowing for replication and comparison studies, to develop a firm research evidence base.     

The organizational context of children's mental health services

This paper reviews what is known about the organizational context of children's mental health services and describes organizational constructs, conceptual models, research methods, and intervention strategies that can be used to link organizational context to service quality and outcomes. Using evidence from studies of business and industrial organizations as well as studies of children's service organizations, the paper presents a model of organizational effectiveness that depends on several contextual characteristics that include organizational culture, structure, climate, and work attitudes. These characteristics are believed to affect the adoption of efficacious treatments (EBPs [evidence-based practices]), adherence to treatment protocols, therapeutic alliance, and the availability, responsiveness, and continuity of services. Finally, 10 components of the ARC(Availability Responsiveness and Continuity) organizational intervention are described as examples of strategies that can be used to develop organizational contexts with the prescribed characteristics. Mental health researchers are encouraged to consider including these constructs, conceptual models, research methods, and intervention strategies in dissemination, effectiveness, and implementation studies that address the gap between research-based knowledge about mental health treatment and what is actually offered in the community.     

A Systematic Review of Trauma Interventions in Native Communities

American Indian/Alaska Native and First Nations communities suffer from health disparities associated with multiple forms of trauma exposure. Culturally appropriate interventions are needed to heal current and historical trauma wounds. Although there are evidence-based trauma interventions for other populations, few have been implemented or evaluated with Native communities. Understanding the extant research on trauma interventions in Native communities is crucial for advancing science and filling gaps in the evidence base, and for meeting the needs of underserved people. In this systematic review of the literature on trauma interventions in Native communities in the United States, Canada, Australia, and New Zealand, we identified 15 studies representing 10 interventions for historical and/or current trauma. These studies involved the community to some extent in developing or culturally adapting the interventions and suggested positive outcomes with regard to historical and interpersonal trauma symptoms. However, notable limitations in study design and research methods limit both internal validity and external validity of these conclusions. Only one study attempted (but did not achieve) a quasi-experimental design, and small sample sizes were persistent limitations across studies. Recommendations for researchers include working in partnership with Native communities to overcome barriers to trauma intervention research and to increase the rigor of the studies so that ongoing efforts to treat trauma can yield publishable data and communities can secure funding for intervention research.     

Prevalence,dynamic risk factors and the efficacy of primary interventions for adolescent dating violence: An international review

Adolescent dating violence is a pressing international issue: yet, there have been few attempts to collate the international evidence regarding this phenomenon. This article reviews contemporary evidence from Europe and North America on prevalence, dynamic risk factors, and the efficacy of intervention programs for adolescent dating violence. Prevalence findings suggest that victimization rates are comparable across Europe and North America. Although individual studies report differing prevalences, the overall hierarchy of violence types – in which psychological/emotional violence is most and sexual violence least prevalent – is consistent across almost all investigations. Four dynamic risk factors for perpetration are identified: peer influence, substance use, psychological adjustment and competencies, and attitudes towards violence. Peer influences and attitudes towards violence appear to be the most extensively evidenced factors in the literature. Nine existing intervention programs are identified, all located within North America. Intervention results are mixed, with some evaluations reporting significant long-term benefits while others report positive intervention effects dissipate throughout follow-up. Tentative analysis suggests that programs focused on behavioral change may elicit sustainable effects more readily. However, this is difficult to ascertain with no data on program repetitions and variations across intervention pedagogy and sample. Concerns with existing research and interventions and possible future directions are discussed.     

A review of acute stress reactions among victims of violence:

This article reviews research pertaining to the psychological trauma occurring in the immediate aftermath of interpersonal violence. The literature surveyed includes studies of victims and observers of various forms of interpersonal violence: rape, threats by a patient, legal execution, terrorist attack, ambush, and assassination, mass shootings, and other forms of homicide. The empirical evidence indicates that individuals commonly experience disruptive psychological symptoms immediately following violence. Further, there is evidence that acute stress reactions can lead to posttraumatic stress disorder (PTSD). The limited amount of research conducted on treatment interventions on acute stress reactions to violence indicates that there is not one best intervention. However, the high prevalence of acute stress reactions among victims immediately following interpersonal violence, coupled with evidence that acute stress symptoms predict PTSD, underscore the importance of providing early intervention to victims of interpersonal violence.     

Family-based physical activity interventions and family functioning: A systematic review

Family physical activity (PA) can confer multiple health benefits, yet whether PA interventions affect general family functioning has not been appraised. The purpose of this review was to evaluate studies that have examined the effect of family PA interventions, where child PA was the focus of the intervention, on constructs of family functioning. Literature searches were concluded on January 11, 2022 using seven common databases. Eligible studies were in English, utilized a family PA intervention, and assessed a measure of family functioning as a study outcome. The initial search yielded 8413 hits, which was reduced to 20 independent PA interventions of mixed quality after screening for eligibility criteria. There was mixed evidence for whether family PA interventions affected overall family functioning; however, analyses of subdomains indicated that family cohesion is improved by PA interventions when children are in the early school years (aged 5–12). High-quality studies also showed an impact of family PA interventions on family organization. Targeted interventions at specific family subsystems (e.g., father–son, mother–daughter), characteristics (low-income, clinical populations, girls), and broad multibehavioral interventions may have the most reliable effects. Overall, the findings show that family PA interventions can promote family cohesion and organization, particularly among families with children in the early school years. Higher quality research, employing randomized trial designs and targeting specific intervention and sample characteristics (e.g., different clinical conditions, specific parent–child dyads), is recommended in order to better ascertain the effectiveness of these approaches.     

Efficacy of Cognitive Rehabilitation Therapies for Mild Cognitive Impairment (MCI) in Older Adults: Working Toward a Theoretical Model and Evidence-Based Interventions

To evaluate the efficacy of cognitive rehabilitation therapies (CRTs) for mild cognitive impairment (MCI). Our review revealed a need for evidence-based treatments for MCI and a lack of a theoretical rehabilitation model to guide the development and evaluation of these interventions. We have thus proposed a theoretical rehabilitation model of MCI that yields key intervention targets–cognitive compromise, functional compromise, neuropsychiatric symptoms, and modifiable risk and protective factors known to be associated with MCI and dementia. Our model additionally defines specific cognitive rehabilitation approaches that may directly or indirectly target key outcomes–restorative cognitive training, compensatory cognitive training, lifestyle interventions, and psychotherapeutic techniques. Fourteen randomized controlled trials met inclusion criteria and were reviewed. Studies markedly varied in terms of intervention approaches and selected outcome measures and were frequently hampered by design limitations. The bulk of the evidence suggested that CRTs can change targeted behaviors in individuals with MCI and that CRTs are associated with improvements in objective cognitive performance, but the pattern of effects on specific cognitive domains was inconsistent across studies. Other important outcomes (i.e., daily functioning, quality of life, neuropsychiatric symptom severity) were infrequently assessed across studies. Few studies evaluated long-term outcomes or the impact of CRTs on conversion rates from MCI to dementia or normal cognition. Overall, results from trials are promising but inconclusive. Additional well-designed and adequately powered trials are warranted and required before CRTs for MCI can be considered evidence-based.     

School-Based Supports and Interventions to Improve Social and Behavioral Outcomes with Racially and Ethnically Minoritized Youth: A Review of Recent Quantitative Research

School discipline disproportionality has long been documented in educational research, primarily impacting Black/African American and non-White Hispanic/Latinx students. In response, federal policymakers have encouraged educators to change their disciplinary practice, emphasizing that more proactive support is critical to promoting students’ social and behavioral outcomes in school. Results from a literature review conducted nearly a decade ago indicated that there was, at that point, a paucity of empirical research related to considering students’ culture (e.g., race, ethnicity) and supporting school behavior. The purpose of this study is to replicate and expand the previous review to summarize the characteristics of the most recent school-based quantitative research addressing interventions to promote social and behavioral outcomes for racially and ethnically minoritized youth. We screened 1687 articles for inclusion in the review. Upon coding 32 eligible research studies, we found that intervention and implementer characteristics within these studies varied, but noted strong intervention effects in studies that included established evidence-based practices, adapted interventions, as well as new practices piloted with student participants. Results inform recommendations to continue to study interventions that promote positive social and behavioral outcomes for racially and ethnically minoritized students to disrupt a long history of subjection to exclusionary discipline disproportionately.

     

What works to change identity? A rapid evidence assessment of interventions

This paper describes the results of a rapid evidence assessment that aimed to identify the characteristics and efficacy of interventions that aimed to or reportedly changed personal or social identity. Following a rapid but systematic search of the published, peer-reviewed research on identity change, 400 studies or reviews were screened for eligibility for inclusion in the review, and 22 were retained. The interventions and samples were diverse and studies came from a broad geographic area. The quality of the research varied, but the majority was assessed as carrying a low weight of evidence. Just under two-thirds of the studies were qualitative, and most explored, retrospectively, participants' perceptions of, or applied theoretical frameworks to, identity change sometime after an intervention. Quantitative studies provided little evidence of the effectiveness of interventions in changing identity. Qualitative studies most commonly applied and then supported the Social Identity Theory of Identity Change to explain perceived changes in identity. Implications for research are discussed.     

A systematic review of the evidence base for Schema Therapy

Schema Therapy is becoming an increasingly popular psychological model for working with individuals who have a variety of mental health and personality difficulties. The aim of this review is to look at the current evidence base for Schema Therapy and highlight directions for further research. A systematic search of the literature was conducted up until January 2011. All studies that had clinically tested the efficacy of Schema Therapy as described by Jeffrey Young (1994 and 2003) were considered. These studies underwent detailed quality assessments based on Scottish Intercollegiate Guidelines Network (SIGN-50) culminating in 12 studies being included in the review. The culminative message (both from the popularity of this model and the medium-to-large effect sizes) is of a theory that has already demonstrated clinically effective outcomes in a small number of studies and that would benefit from ongoing research and development with complex client groups. It is imperative that psychological practice be guided by high-quality research that demonstrates efficacious, evidence-based interventions. It is therefore recommended that researchers and clinicians working with Schema Therapy seek to build on these positive outcomes and further demonstrate the clinical effectiveness of this model through ongoing research.     

Guidelines for classifying evidence-based treatments in couple and family therapy

Guidelines for Evidence-Based Treatments in Family Therapy are intended to help guide clinicians, researchers, and policy makers in identifying specific clinical interventions and treatment programs for couples and families that have scientifically based evidence to support their efficacy. In contrast to criteria, which simply identify treatments that "work" and have been employed in the evaluation of other psychotherapies, these guidelines propose a three-tiered levels-of-evidence-based model that moves from "evidence-informed," to "evidence-based," to "evidence-based and ready for dissemination and transportation within diverse community settings." Each level reflects an interaction between the specificity of the intervention, the strength and readth of the outcomes, and the quality of the studies that form the evidence. These guidelines uniquely promote a clinically based "matrix" approach in which the empirical support is evaluated according to various dimensions including strength of the outcomes, the applicability across cultural contexts, and demonstration of specific change mechanisms. The guidelines are offered not only as a basis for understanding the evidence for diverse clinical approaches in couple and family therapy within the systemic tradition of the field, but also as an alternative aspirational model for evaluating all psychotherapies.