The Partners for Change Outcome Management System: A Both/And System for Collaborative Practice

Systematic client feedback (SCF) is increasingly employed in mental health services worldwide. While research supports its efficacy over treatment as usual, clinicians, especially those who highly value relational practices, may be concerned that routine data collection detracts from clinical process. This article describes one SCF system, the Partners for Change Outcome Management System (PCOMS), along a normative (standardized measurement) to communicative (conversational) continuum, highlighting PCOMS’ origins in everyday clinical practice. The authors contend that PCOMS represents “both/and,” providing a valid signal of client progress while facilitating communicative process particularly prized by family therapists steeped in relational traditions. The article discusses application of PCOMS in systemic practice and describes how it actualizes time‐honored family therapy approaches. The importance of giving voice to individualized client experience is emphasized.     

Associations between parent perceived social cognitive factors and child objectively measured physical activity behaviors among preschool-aged children

Grounded in social cognitive theory (SCT), this study sought to examine whether parents perceived social cognitive factors regarding children's physical activity (PA) behaviors were associated with preschool children's moderate-to-vigorous PA (MVPA) levels. A total of 142 Hong Kong parent-child pairs from five preschools/childcare centers completed all assessments in the cross-sectional study. Children’s (42% girls; mean age = 4.52 ± 0.67 years) PA was measured through accelerometers. Parents (74% mothers; mean age = 37.38 ± 4.63 years) completed a paper-based questionnaire assessing the social cognitive factors on their children’s PA participation. The data were analyzed using latent variable structural equation modeling. Findings revealed that the model showed acceptable fit with the data: χ² (23) = 38.14, p = .025, χ²/df = 1.66, CFI = 0.955, TLI = 0.929, RMSEA = 0.068, 90% CI [0.025, 0.106], and SRMR = 0.072. The model accounted for 39.1% of the variance in the PA behavior of preschool-aged children. Structural equation modelling revealed parental self-efficacy (β = 0.29, 95% CI [0.95, 0.49]) and goal setting (β = 0.25, 95% CI [0.06, 0.44]) were directly associated with children’s MVPA. Outcome expectations (β = 0.09, 95% CI [0.01, 0.03]) and goal setting (β = 0.18, 95% CI [0.05, 0.32]) mediated the association between parental self-efficacy and children’s MVPA. Indirect associations of parental self-efficacy from setting goals via parental support (β = 0.15, 95%CI [0.02, 0.30]) and perceived barriers (β = 0.15, 95% CI [0.05, 0.28]) were uncovered. Results supported the use of SCT in understanding how the parents perceived social cognitive factors predict the PA behaviors of young children. This study provides insight into whether these theoretical variables could be modified or promoted in future intervention programs. Enhancing parents’ abilities to ensure preschool-aged children are physically active is of great importance given the global decline in PA among children.     

Heterogeneity of treatment changes after psychodynamic therapy within a one year follow‐up: A replication study

Naturalistic psychotherapy effect studies commonly report effect sizes for the total sample. However, a previous study of SCL‐90 Global Severity Index (GSI) improvement in a large outpatient sample used a cluster analytic strategy and reported clinical relevant outcome trajectories that could be grouped into early within‐treatment improvement, late improvement in the follow‐up period, and deteriorating patients with slight improvement that was lost at follow‐up. We explore GSI outcome trajectories and clinical significant change in a sample of 320 patients at a public psychiatric outpatient psychodynamic group therapy unit, the majority with anxiety, personality, and mood disorders. The study revealed large discharge and follow‐up effect sizes but more than one third of the patients were without measurable improvement. The major clusters described above were confirmed, and revealed unique clinical and socio‐demographic characteristics. Late improvers, as compared with early improvers, were characterized by anxiety symptoms and lack of network support after controlling for GSI at admission. Similarly, deteriorating patients had longer duration of illness and less favourable social characteristics compared with the other two groups. Early improving patients were less likely to have participated in short‐term groups, and only one third participated in additional treatment compared with more than 69% of the other patients. Severe and socially affected psychiatric patients, and patients with anxiety and agoraphobic symptoms may be less optimally treated in short‐term time limited psychodynamic groups. There is an obvious need for diversity of treatment offers, better integration of psycho‐social treatment components, and long‐term open ended treatment.     

The relationships between personality traits and one-year outcomes in patients with major depressive disorder without psychotic features

Introduction

Besides the intensity of depression, the main predictors of the outcome of a depressive episode are the comorbid disorders and certain personality traits.

Effect of developmental care for very premature infants on neurodevelopmental outcome at 2 years of age

BackgroundTo determine the effect of developmental care on neurodevelopmental outcome in formerly preterm infants at a corrected age of 2 years.MethodsA prospective phase-lag study was performed at an Austrian neonatal intensive care unit (NICU). From January 2003 to December 2005 (study period of conventional care) and January 2007 to December 2009 (study period of developmental care), we enrolled all infants born in Tyrol at less than 32 weeks of gestation. During this period a total of 261 of 359 preterm infants (participation rate 72.7%) completed the follow-up visit at 2 years of age; there were 124 children in the conventional and 137 in the developmental care group. The association between developmental care and delayed motor or mental development (Bayley Scales of Infant Development II; psychomotor or mental developmental index <85) was analyzed by means of logistic regression analysis at a corrected age of 24 months.ResultsChildren in the developmental care group showed less psychomotor delay than did those in the control group (developmental care group: 16.1%, conventional care group 27.4%; adjusted odds ratio 0.37 [95% confidence interval: 0.19–0.74], P = 0.005). Not smoking in pregnancy and higher gestational age were also significant predictors for a better psychomotor outcome at 2 years of age. Regarding cognitive outcome, no significant difference was observed between these two groups.ConclusionOur data implicate that developmental care may result in an improved 2-year psychomotor outcome in formerly preterm infants.     

Treatment Effectiveness of PMTO for Children's Behavior Problems in Iceland: Child Outcomes in a Nationwide Randomized Controlled Trial

Well‐documented treatment methods must be tested following their implementation in community service agencies and across different cultures to ensure continuing effectiveness. This study was a randomized controlled trial (RCT) of Parent Management Training—the Oregon model (PMTO), conducted within a nationwide implementation in Iceland. Families of 102 clinically referred children with behavior problems were recruited from five municipalities throughout Iceland. Child age ranged from 5 to 12; 73% were boys. Families were randomly assigned to either PMTO or services usually offered in the communities (SAU). Child adjustment was measured with a latent construct based on parent, child, and teacher reports of externalizing and internalizing problems and social skills. Prepost intent‐to‐treat analyses showed that PMTO treatment led to greater reductions in child adjustment problems relative to the comparison group, obtaining a modest to medium effect size based on the construct score. Only one indicator (parent‐rated Social Skills) showed significant change independently and information on amount and kind of treatment in the SAU was limited. Overall, findings indicate that PMTO is an effective method to treat children's behavior problems in a Northern European culture and supply evidence for the method's successful implementation in community settings in Iceland. This is one of few nationwide implementation studies of PMTO outside the United States and the first RCT in Iceland to test a treatment model for children's behavior problems.     

Feedback Informed Treatment: Evidence‐Based Practice Meets Social Construction

This article explores the challenges presented by the mandate for evidence‐based practice for family therapists who identify with the philosophical stance of social construction. The history of psychotherapy outcome research is reviewed, as are current findings that provide empirical evidence for an engaged, dialogic practice. The authors suggest that the binary between empiricism and social construction may be unhinged by understanding empiricism as a particular discursive frame (i.e., a particular way of talking, acting, and being in the world), one of many available as a way of understanding and talking about our work. Through a case vignette, the authors introduce the evidence‐based practice of Feedback Informed Treatment as an elaboration of social construction, and as an example of bridging the gap between the discursive frames of empiricism and social construction.     

The heart of the matter: a proposal for placing the self of the therapist at the center of family therapy research and training

As it faces the transition marked by the death or retirement of most of its first-generation founders, the field of family therapy finds itself still unable to answer the critical question of what it is that makes family therapy work. The two dominant approaches to answering this question, the common-factors perspective and the model-specific factors perspective, remain divided at this juncture by a fundamental difference of emphasis between the two. This article proposes a way of integrating the two perspectives via the hypothesis that therapists achieve maximum effectiveness by committing themselves to a family therapy model of proven efficacy whose underlying worldview closely matches their own personal worldview. The implications of this hypothesis for the training of family therapists are examined.     

Outcome interdependence shapes the effects of prevention focus on team processes and performance

Although the effects of regulatory focus on individual-level performance have often been studied, relatively little is yet known about team-level effects. Filling this void, we integrate the notion that promotion-focused individuals are concerned with progress and achievement, whereas prevention-focused individuals are concerned with security and vigilance, with the insight that team processes and performance depend on outcome interdependence (individual versus team rewards). The hypothesis that prevention-focused teams react more strongly than promotion-focused teams to differences in outcome interdependence was tested among 50 teams performing an interactive command-and-control simulation. Regulatory focus and outcome interdependence were both manipulated. The results showed that prevention-focused teams working for team rather than individual rewards reported higher work engagement and less error intolerance, coordinated more effectively, and performed better. Promotion-focused teams were not influenced by outcome interdependence. We discuss the implications of our results for theory and effective team management.