The Evidence Base for Occupational Therapy in Mental Health: More Systematic Reviews Are Needed

To shape its work, the Research Centre for Occupation & Mental Health is interested in research priorities. Systematic reviews develop an overview of the research available about an intervention, which can provide evidence to underpin practice. They also however, identify gaps in the knowledge base and so are useful for research-prioritization exercises. A rigorous literature search identified only four systematic reviews about occupational therapy in mental health, which suggests that more are needed to underpin practice. This article also explains a six-stage process for conducting a systematic review that can be used by occupational therapists in mental health.     

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.     

Navigating the Road Ahead: Public Health Challenges and the Interactive Systems Framework for Dissemination and Implementation

Public health is currently faced with an array of critical challenges and disconnects. Research and evaluation have identified a number of evidence‐based strategies for effecting behavior change at individual, group, organizational, and environmental levels, all of which hold promise for leading to substantial reductions in morbidity and mortality, and increased quality of life. Unfortunately, there is huge variability across the public health system in awareness of the value of using evidence to inform decision making, let alone in capacity to locate, assess, compare, select, justify, adapt, implement, and evaluate evidence‐based strategies, or to participate in building the evidence base for practice‐based innovations. As a result, many communities may not be benefitting from research‐tested and practice‐based strategies that could help them to meet their public health goals more efficiently and effectively. CDC's Interactive Systems Framework for Dissemination and Implementation (ISF), released in 2008, was designed to help close this gap between research and practice. This commentary identifies the ways in which the ISF framework is useful in addressing the research practice gap; revisits the elements of the framework that have continued to guide research and practice in fruitful ways; and highlights areas that need further development to meet current public health challenges. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

A Community's Response to Adverse Childhood Experiences: Building a Resilient,Trauma‐Informed Community

Adverse childhood experiences, or ACEs, may be mitigated by trauma‐informed social environments—programs, services, systems, communities—that offer responses to trauma that promote healing, recovery, and resilience. However, there is currently little empirical evidence to support the use of specific approaches to do so. Guided by a population health perspective, this paper describes a participatory community change process in response to ACEs that seeks to build a resilient, trauma‐informed community in Pottstown, PA. We examine the initial implementation phase of this change process, centered originally on the education sector and the social and behavioral health services sector, and then eventually expanding to 14 community sectors across two years. A variety of data sources and methods are used to track individual and organizational processes, as well as service system network processes. A central feature of this research is the use of data to generate hypotheses rather than test them. Data were also used to guide understanding and decision‐making during implementation. The results show that moving forward the community is well‐positioned to establish stronger inter‐agency and system supports for trauma‐informed practice in the service system and in the broader community. We discuss results for their implications for building resilient, trauma‐informed communities.     

Whistle-Blowing from the Perspective of General Strain Theory

Authorities in many countries rely on whistle-blowing systems to boost control of organizational deviance. It can hardly be answered whether this practice is legitimate and efficient without knowing the patterns of whistle-blower behavior. So far, little is known about the development process as an interaction of specific individual, organizational, and situational conditions that spawns especially external reports. This article reconstructs such typical progressions based on interviews with whistle-blowers in Germany and from the perspective of the General Strain Theory. It turns out that external whistle-blowing is often the result of an escalating conflict that can be interpreted as a very personal experience of strain.     

Evaluating School Readiness to Implement Positive Behavioral Supports

ABSTRACT

One state's efforts to assess school readiness to implement a comprehensive mental health innovation are described. To determine the likelihood of achieving success with positive behavioral supports (PBS), a process to identify school buildings ready for planned organizational change was designed and implemented within a large-scale system of care initiative in southeastern Kentucky. The salient features of the innovation are discussed, the process used to design and implement the approach is delineated, and limitations and implications of this method are considered. This multi-systemic intervention can serve as an example of the practice of organizational school psychology.     

Ready, Willing, and Able: Developing a Support System to Promote Implementation of School-Based Prevention Programs

While the number and scope of evidence‐based health, education, and mental health services continues to grow, the movement of these practices into schools and other practice settings remains a complex and haphazard process. The purpose of this paper is to describe and present initial support for a prevention support system designed to promote high‐quality implementation of whole school prevention initiatives in elementary and middle schools. The function and strategies of a school‐based prevention support system are discussed, including key structures and activities undertaken to identify, select, and provide technical assistance to school personnel. Data collected over a 5 year period are presented, including evidence of successful implementation support for 5 different evidence‐based programs implemented with fidelity at 12 schools and preliminary evidence of goal attainment. Findings suggest the ongoing collection of information related to organizational readiness assists in the adoption and implementation of effective practices and initiatives and provide valuable insight into the development of results‐oriented approaches to prevention service delivery. Problems, progress, and lessons learned through this process are discussed to frame future research and action steps for this school‐based prevention support system. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

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.     

Bringing the Organization into Organizational Research: An Examination of Academic Research Inside Organizations

One common suggestion for reducing the gap between research and practice is for academics to conduct more of their research in real organizational settings. However, there is considerable skepticism among academics about the willingness of organizations to open their doors to researchers, and among both academics and practitioners about the potential value of doing so. The present study examines how 141 successful academic research projects in real organizations proceeded from start to finish. Our results suggest that organizations may be more open to academic research than is commonly believed, and that most researchers experience few problems with participating organizations. On the other hand, most of the examined projects were not heavily collaborative, and only half of the researchers maintained organizational contact after the research was completed. Based on our findings, we offer suggestions for researchers wishing to do organizational research as well as for their organizational partners.     

Organizational Competencies: A Valid Approach for the Future?

This paper attempts to integrate concepts of organizational competency across a number of levels of analysis. It provides grounded evidence on existing application and practice, and synthesizes research and development in the area of organizationally derived management competencies. Consideration is given to the underlying theoretical assumptions and definitional issues raised by existing practice. The paper highlights the range of human resource strategies or programmes used to integrate activity and implement strategic changes, and examines the shift in thinking about the importance and nature of management competency. Organization-specific approaches are reviewed and the benefits analysed. A critical review of attempts at integration suggests that application of competency-based approaches within organizations has fallen behind advances in strategic human resource management and that there is a need to shift application towards more future–oriented and strategic contexts. Weaknesses associated with existing approaches to management competency are analysed as is the issue of validity. Finally, the implications of considering competencies as an organizational level resource for human resource strategy are discussed.     

Applied conversation analysis for counselling and psychotherapy researchers

Applied Conversation Analysis (CA) is broadly accepted to be a qualitative methodological approach associated with the discursive turn. Although some argue for a distinct observational science paradigm, the current methodological dichotomy positions this work under the qualitative rubric. Applied CA focuses on the sequential design of social interaction, examining language and meaning within institutional settings. It emphasises informing practice and provides a useful form of evidence for therapists and counsellors, as the work is grounded in real‐world therapeutic practices. In therapy, language and talk are fundamental to the process and outcomes. Studying therapeutic social interaction through Applied CA can illuminate processes, improve practice, and utilise best practice to inform care. The focus of this article is our perspective on the value of Applied CA as a form of evidence in counselling and psychotherapy, and to encourage partnership working between academics and clinicians working in the field.     

The multi-level approach: a road map for couples therapy

This paper presents a multi-level framework and road map to guide the therapeutic process. Starting with the couple's reactive pattern, the multi-level approach first orients the therapist on how to create a "holding environment." It then suggests how the therapist, in collaboration with the couple, can proceed to explore interactional, sociocultural/ organizational, intrapsychic, and intergenerational processes that might be fueling the couple's dynamics. Central to this approach is the construct of the vulnerability cycle, a nexus of integration that helps the therapist stay anchored while moving through the many layers of therapeutic work. The overall goal is to help the partners move from reactivity to responsibility for their own feelings and behavior; from impasse to a greater ability to reflect, express feelings, listen, negotiate, and make choices about how to be in the relationship. This paper describes a range of concepts and interventions from basic to complex; it is intended as an organizational tool for practice and clinical training.     

Narrative Approaches to Organizational Development: A Case Study of Implementation of Collaborative Helping

Across North America, community agencies and state/provincial jurisdictions are embracing family‐centered approaches to service delivery that are grounded in strength‐based, culturally responsive, accountable partnerships with families. This article details a collaborative consultation process to initiate and sustain organizational change toward this effort. It draws on innovative ideas from narrative theory, organizational development, and implementation science to highlight a three component approach. This approach includes the use of appreciative inquiry focus groups to elicit existing best practices, the provision of clinical training, and ongoing coaching with practice leaders to build on those better moments and develop concrete practice frameworks, and leadership coaching and organizational consultation to develop organizational structures that institutionalize family‐centered practice. While the article uses a principle‐based practice framework, Collaborative Helping, to illustrate this process, the approach is applicable with a variety of clinical frameworks grounded in family‐centered values and principles.     

The couch as icon

The couch has always been an integral part of psychoanalytic practice. It has even become a cultural icon representing psychoanalysis itself. However, minimal evidence exists in the psychoanalytic literature that using the couch is necessary or even necessarily helpful to establish a psychoanalytic process and conduct an analysis. Furthermore, it can potentially be harmful to patients such as those who have experienced early loss and trauma or who have significant ego organizational problems. Therefore, the use of the couch per se does not seem well suited as a defining criterion of psychoanalysis. To the extent that it may be clinically valuable, the use of the couch should be more carefully considered and critically examined.     

Academic perceptions of the research evidence base in work and organizational psychology: A European perspective

There has been a growing interest in evidence‐based management. A core component is a body of high‐quality research evidence to inform practice. Initial research with human resource managers in the United States and the Netherlands reveals only modest knowledge about a number of ‘widely documented’ research findings. However, it is unclear whether research experts would display any greater agreement about the research evidence. The present study addresses this issue by exploring levels of agreement about the quality of the research evidence base in work and organizational (W/O) psychology using a pan‐European sample of 75 senior academic W/O psychologists who completed two rounds of a study, first identifying core findings in the field of W/O psychology and then reporting levels of agreement about them. The results show that there were only seven of 24 core findings on which over 75% agreed that there was good‐quality evidence. The challenges of developing and utilizing an evidence‐based approach are discussed and it is concluded, in agreement with Briner and Rousseau (2011a), that there is some way to go before W/O psychologists can begin to feel confident about the quality of much of their research evidence.     

A Qualitative Study of Health Professionals' Views Regarding Provision of Information About Health-Protective Behaviors During Genetic Consultation for Breast Cancer

This study aimed to explore health professionals' views and practice regarding the provision of information about health-protective behaviors (e.g., exercise, alcohol consumption, diet) during genetic consultation for breast cancer. Ten genetic counselors participated in three focus groups, and seven medical specialists were interviewed in a focus group or individually. Data was analyzed using the constant comparative method. Findings suggested that health professionals held differing, often opposing, views about the value of health-protective behaviors for women at increased risk of breast cancer. The content and extent of information provided about health-protective behaviors varied widely, and participants expressed a need to form consensus regarding information provision both within and across clinics. The main barriers to providing information regarding health-protective behaviors included the lack of research evidence regarding the impact of these factors and higher priority of other information need to be provided in the limited consultation time. Participants generally did not consider it their role to promote health-protective behaviors, and were concerned about the psychological impact of providing information about behavioral risk factors during genetic consultations.     

Procedural Justice and Perceptions of Fairness in Selection Practice

Demonstrating procedural justice through a focus on the psychometric job-related approach to selection continues to be the most effective means for employers to meet legal requirements and potential claims of unfair treatment. A study of selection practice in a large local UK City Council reports how a structured, highly ‘job-focused’ approach can result in negative perceptions about the fairness of the process, its outcomes and effectiveness. Its findings reveal an organizational dilemma – how to develop selection systems that are sufficiently robust in terms of demonstrating maximum procedural fairness and objectivity to withstand potential litigation but are sufficiently flexible to accommodate those other factors which influence individual perceptions of fairness. It considers the future of the highly structured approach in the light of pressures to develop selection processes which can meet the needs of rapidly changing organizational structures as well the expansion of anti-discrimination legislation and litigation.     

An assessment of manager/subordinate perceptions of performance appraisal effectiveness

This study postulates that performance appraisal will be effective to the extent that managers and subordinates have a shared perception of its purpose and function and the degree to which it meets the needs of both groups. A two part research project was conducted to: 1) identify manager/subordinate perceptions of the purposes served by the formal performance appraisal process; 2) determine the extent to which these purposes are being satisfied in organizational practice; and 3) assess if managers and subordinates have a shared perception of the effectiveness of the appraisal process. The sample for the study included 36 managers and 143 subordinates from a division of a large Midwest service organization. The results were mixed with regard to the appraisal system effectively accomplishing its diverse goals. However, in general, there was support for the notion that both managers and subordinates find the appraisal process to be a worthwhile organizational practice. Approximately 70% of the respondents indicated that they would participate in the appraisal program whether they were required to do so or not.     

Psychometrics of a simple method for scoring organizational approach on the Rey‐Osterrieth complex figure

The Rey‐Osterrieth Complex Figure (ROCF) is a commonly used neuropsychological measure that assesses visuospatial processing, planning and visuomotor integration. Using samples of clinically referred (N=20) and non‐clinical (N=44) adults, the present study examines the psychometric properties of a simple method of scoring organizational approach to the ROCF. Developed by Savage et al. (1999) and refined by Deckersbach et al. (2000) , this simple 5‐point organizational scoring system allows for the quick and accurate assessment of organizational quality. Results suggest that this system is internally consistent and can be scored reliably. Correlations with measures of visuomotor integration and accuracy of rendition after a delay provide evidence of convergent validity. Organization scores were independent of both Verbal and Performance IQ estimates. However, discriminant validity analyses found that high‐functioning patients referred for a neuropsychological assessment did not score significantly different from a non‐clinical sample, raising questions about the diagnostic utility of this measure with less impaired populations. Implications for clinical practice are discussed, as are directions for future research.