Updating the Textbook: A Novel Approach to Training Graduate Students in Evidence-Based Youth Practices

Despite the ever-improving base of evidence-based practices (EBPs) for the treatment of childhood disorders, a gap between EBP research and their use in community settings continues to exist. An exciting opportunity to close this gap exists in the form of graduate student training; however, at present, several roadblocks exist. In this paper, we review the current state of graduate training in delivering EBPs and obstacles involved in training future community clinicians (i.e., graduate students) in EBPs. Next, we describe in detail our initiative to develop a curriculum that addresses these challenges. This innovative course empowered graduate students to receive training in the delivery of youth EBPs in community settings through reviews of the research literature, active learning techniques (e.g., discussions of case conceptualizations, role-playing case studies), and a written, publication-quality review of EBPs. Finally, we offer recommendations for other educators of mental health professionals (e.g., psychologists, social workers, counselors) to improve upon this curriculum in their training of graduate students in the theory and application of EBPs for treating childhood disorders.     

Alliance

The alliance highlights the qualities of coordination, sincerity, and trust that run through the various (CBT) interventions. This commemoration of Dr. Aaron T. Beck’s contribution to the field focuses on the alliance that emerges as one of the best-studied process characteristics in psychotherapy, with hundreds of studies on different orientations, treatment conditions, and mental health services. Overall, there is a robust meta-analytic predictive relation between alliance during therapy and therapy outcome (Cohen's d = .58). However, socio-cultural aspects such as the existence of substance use disorder or ethnic minorities partly moderates this relation. In addition, therapist effects are likely. Clinical implications are discussed based on the excellent meta-analytic empirical evidence.     

Exploring Modifications to Individual Trauma-Focused PTSD Treatments in a Routine Care Setting: An Examination of Medical Records at a Veterans Health Administration PTSD Clinic

Clinicians in naturalistic settings regularly modify the delivery of trauma-focused treatments to enhance client engagement and retention. However, what types of modifications are made in clinical settings, why, and when, and their impact on client outcomes has seldom been examined. As an initial step to address this, the current study applied elements of the updated Framework for Reporting Adaptations and Modifications—Expanded (FRAME; Wilstey Stirman et al., 2019) to examine content-level modifications documented in the delivery of posttraumatic stress disorder (PTSD) treatment to veterans via medical records review in an urban PTSD clinic. Results indicated that the updated FRAME suited the data well, and that modifications occurred in most veteran–clinician pairs over the course of treatment. The four most common modifications documented were spreading (27%), repeating (24%), drift with return (22%), and integrating (21%). Three composite case examples are discussed that describe the application of the most common modifications observed in medical record documentation. This is an important first step toward understanding the real-world modifications of evidence-based trauma-focused interventions that in turn will lead to critical recommendations for improving treatment implementation.     

借鉴循证医学方法促进SARS治疗决策科学化

面对突如其来的严重急性呼吸综合征(SARS),其预防和治疗方案层出不穷.究竟哪一种预防或治疗方法对SARS最有效?怎样面对现有的困难?如何借鉴循证医学的理念及方法,促进SARS治疗决策科学化至关重要.     

Defining Treatment Outcomes in Pediatric Obsessive-Compulsive Disorder Using a Self-Report Scale

This study examined benchmarks of treatment response and clinical remission on the Obsessive Compulsive Inventory–Child Version (OCI-CV) for youth with obsessive-compulsive disorder (OCD). Participants were 91 youth who enrolled in a randomized controlled trial that examined the benefit of augmenting cognitive behavior therapy (CBT) with either d-cycloserine or placebo. Youth completed the OCI-CV at baseline, Week 4 (prior to initiating exposure therapy), and posttreatment. Receiver operator curve (ROC) analyses examined optimal benchmarks for treatment response and clinical remission as identified by independent evaluators at the posttreatment assessment using the Clinical Global Impression (CGI) scales of Improvement (CGI-Improvement), Severity (CGI-Severity), and Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Optimal benchmarks for treatment response were a 20%–25% reduction in the OCI-CV total score. Meanwhile, optimal benchmarks for remission were a 55%–65% reduction in the OCI-CV total score and a posttreatment total score ≤ 6-8. OCI-CV benchmarks exhibited moderate agreement with the CY-BOCS for treatment response and clinical remission. Meanwhile, fair agreement was observed for response and remission with CGI scales. A lower pretreatment OCI-CV total score was associated with less agreement between classification approaches. Findings provide benchmarks for classifying treatment response and clinical remission in an efficient manner. Given the moderate agreement between the CY-BOCS and OCI-CV benchmarks, the OCI-CV may serve as a useful alternative when clinician-rated scales cannot be administered due to limited resources (e.g., time, training). Thus, evidence-based measurement can be incorporated to monitor therapeutic response and remission in clinical practice.     

Initiation of evidence-based psychotherapies in Veterans with posttraumatic stress disorder

The Department of Veterans Affairs (VA) requires that all VA hospitals and clinics provide access to evidence-based psychotherapies (EBPs). Despite these widespread dissemination efforts, only a minority of Veterans receive EBP services. Reasons for these low rates of EBP utilization are largely unknown. This study examined the characteristics of Veterans with posttraumatic stress disorder (PTSD) who did (Initiation group) and did not (No-Initiation group) initiate a VA-approved EBP after participating in an information session. Veterans chose their preferred treatment from a menu of EBPs. Results demonstrated that Veterans in the No-Initiation group had longer periods of time between their referral and first EBP visit. Among Veterans in the Initiation group, the majority (68%) initiated a trauma-focused EBP as their first or second treatment, suggesting that providing a range of treatment options did not negatively impact their willingness to engage in PTSD treatment. Results are discussed in terms of VA initiatives to improve access to and initiation of mental health care for Veterans.     

Guidance on conducting and reviewing systematic reviews (and meta-analyses) in work and organizational psychology

Systematic reviews and meta-analyses are means of summarizing and synthesizing research evidence in a given topic area. They can be used to define the current state of knowledge and how confident we can be in that knowledge, to identify evidence gaps, and to provide recommendations for policy and practice based on the best available evidence. At European Journal of Work and Organizational Psychology, our editorial stance is explicitly to encourage the conduct of systematic reviews and meta-analyses. The purpose of this editorial is to provide some guidance to authors and journal referees on the (technical) features of good systematic reviews.     

Sustainable antibullying program implementation: School profiles and predictors

We examined the sustainability of the KiVa antibullying program in Finland from its nationwide roll-out in 2009 to 2016. Using latent class analyses, we identified four different patterns of implementation. The persistent schools (43%) maintained a high likelihood of participation throughout the study period. The awakened (14%) had a decreasing trend during the first years, but then increased the likelihood of program participation. The tail-offs (20%) decreased in the likelihood of participating after the third year, and the drop-offs (23%) already after the first year. The findings suggest that many schools need support during the initial years to launch and maintain the implementation of evidence-based programs; yet a large proportion of schools manage to sustain the program implementation for several years. The logistic regression analyses showed that large schools persisted more likely than small schools. Lower initial level of victimization was also related to the sustainability of the program. Finally, persistent program participation was predicted by several school-level actions during the initial years of implementing the program. These results imply that the sustainability of evidence-based programs could be enhanced by supporting and guiding schools when setting up the program during the initial implementation.     

Developing an Occupation-Centred Framework for Trauma Intervention

Abstract

Experiencing work-related trauma can negatively impact coping abilities and daily life participation. Occupational therapists (OTs) often provide health services to workers who have experienced trauma, including military members, veterans, and public safety personnel. The Occupational Therapy Trauma Intervention Framework (OTTIF) is a novel clinical reasoning framework that matches a client’s level of readiness to engage with a spectrum of evidence-based OT approaches. Using surveys at two time points, evaluation of therapist experiences of using the OTTIF elicited positive feedback that suggests the OTTIF provides a useful occupation-centred framework for evidence-informed occupational therapy practice with clients who have experienced trauma.