This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e., indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a community mental health agency (CMHA) provided exposure therapy for 8 youth with obsessive–compulsive disorder (OCD). Using a nonconcurrent multiple baseline design with random assignment to baseline lengths of 6 to 16 weeks, therapists received gold-standard exposure therapy training with weekly consultation (baseline phase) followed by addition of EG training and feedback (intervention phase). The primary outcome was therapist behavior during in-session exposures, observed weekly using a validated coding system. Therapist behavior was evaluated in relation to a priori benchmarks derived from clinical trials. Additional outcomes included training feasibility/acceptability, therapist response to case vignettes and beliefs about exposure, and independent evaluator-rated clinical outcomes. Three therapists reached behavior benchmarks only during the EG (intervention) phase. Two therapists met benchmarks during the baseline phase; one of these subsequently moved away from benchmarks but met them again after starting the EG phase. Across all therapists, the percentage of weeks meeting benchmarks was significantly higher during the EG phase (86.4%) vs. the baseline phase (53.2%). Youth participants experienced significant improvement in OCD symptoms and global illness severity from pre- to posttreatment. Results provide initial evidence that adding the EG to gold-standard training can change in-session therapist behaviors in a CMHA setting. 相似文献
A three-level piecewise growth model (3L-PGM) can be used to break up nonlinear growth into multiple components, providing the opportunity to examine potential sources of variation in individual and contextual growth within different segments of the model. The conventional 3L-PGM assumes that the data are strictly hierarchical in nature, where measurement occasions (level 1) are nested within individuals (level 2) who are members of a single cluster (level 3). However, in longitudinal research, it is sometimes difficult for data structures to remain purely clustered during a study, such as when some students change classrooms or schools over time. One resulting data structure in this situation is known as a multiple membership structure, where some lower-level units are members of more than one higher-level unit. The new multiple membership PGM (MM-PGM) extends the 3L-PGM to handle multiple membership data structures frequently found in the social sciences. This study sought to examine the consequences of ignoring individual mobility across clusters when estimating a 3L-PGM in comparison to estimating a MM-PGM. MM-PGM estimates were less biased (especially in the cluster-level coefficient estimates), although we found substantial bias in cluster-level variance components across some conditions for both models. 相似文献
Journal of Philosophical Logic - In Berto’s logic for aboutness in imagination, the output content of an imaginative episode must be part of the initial content of the episode (Berto, Philos... 相似文献
Research on Child and Adolescent Psychopathology - The current longitudinal study examines changes in overall mental health symptomatology from before to after the COVID-19 outbreak in youth from... 相似文献
Journal of Religion and Health - A multi-dimensional construct of Catholic health care is examined using a bibliometric analysis of 181 scientific studies from the Web of Science database. Medical... 相似文献
A robust body of research examines factors affecting the likelihood that women experience increasing barriers to promotion in workplaces. However, limited research examines how racialized and gendered processes may intersect and work differently for racially and gender marginalized workers. Specifically, the processes relating to a worker’s ability to reach middle-level management positions (e.g., those managers who oversee a small group of employees) and senior-level management positions (e.g., CEOs and other executive positions) may vary based on workers’ race and gender. Using 2015 EEO-1 data collected by the U.S. Equal Opportunity Employment Commission (EEOC), we examine how the characteristics of a workplace affect Black men, Black women, White men, and White women’s share of middle- and senior-level management. We find Black women and Black men are strikingly under-represented in both middle and senior management in private-sector workplaces. Our results demonstrate that access to middle- and senior-management varies by the characteristics of the workplace and workers’ race and gender. Overall, our findings point to an important implication: Greater oversight of workplaces, including by the EEOC, is associated with marginalized race/gender groups having higher shares of management.
The jail‐based competency treatment (JBCT) model has become an established forensic practice across the country. From the perspective of implementation science and the three core elements of the Promoting Action on Research Implementation in Health Service (PARiHS) framework, the JBCT model is a remarkable example of how context (an unrelenting and overwhelmingly strong demand for forensic beds) has driven multiple state governments to facilitate implementation of a methodology in the absence of empirical evidence supporting its efficacy. This 7‐year study of outcomes from four JBCT program sites provides this much‐needed evidence by showing that JBCT restored 56% of 1553 male and 336 female patients over an average of 48.7 days. At the same time, the study highlights how variations in JBCT models, methods, and preadmission stabilization time present challenges to planned and effective implementation of evidence‐based practice at the statewide system level. By identifying differential responsiveness to JBCT treatment by diagnosis and other factors, the study suggests preliminary implementation ideas for what types of patients are well served by the JBCT model as part of a continuum of restoration options that includes inpatient, outpatient and diversion. Significant findings showed that JBCT patients were restored at a higher rate and in a shorter time if they were female, < 20 years old (highest restoration rate; those < 60 years old also significantly better rates), free of co‐occurring intellectual and cognitive deficits, and malingering. Of the major diagnoses, schizoaffective disorder required a significantly longer length of JBCT treatment for restoration, and lower restoration rates than schizophrenia and bipolar disorder, although this was moderated by a significant interaction with abuse of amphetamines. 相似文献