Evidence-based Mental Health Practices Research Articles

Impact of Around-the-Clock Mental Health Staffing on Emergency Department Management of Patients Who Deliberately Self-Harm.

Emergency departments (EDs) offer opportunities to deliver critical frontline suicide prevention services via assessment, safety planning, and linkages with community-based mental health care after discharge. Because mental health crises can occur at any time, this study sought to evaluate whether around-the-clock mental health staffing in the ED influences the likelihood of providing these evidence-based mental health services. ED nursing leadership from a national sample of 406 hospitals completed a survey on the ED management of patients who deliberately self-harm, including availability of mental health staff (psychiatrists, psychiatric nurses, psychologists, social workers, other mental health professionals). Analyses examined whether around-the-clock mental health staffing was associated with provision of key assessments, safety planning, and discharge practices, controlling for hospital characteristics. There were no significant differences in the extent to which EDs with and without around-the-clock mental health staff routinely completed recommended assessment practices (71% and 70%, respectively). EDs with around-the-clock mental health staff were more likely than their counterparts to routinely provide two recommended safety planning practices (59% vs. 27%, p<0.001; adjusted odds ratio [AOR]=3.76) and were more likely to routinely schedule follow-up outpatient care (44% vs. 21%, p=0.002; AOR=3.26). Around-the-clock mental health coverage in the ED is associated with routine provision of key safety planning and discharge practices. EDs should have consistent access to staff either in person or remotely to facilitate the delivery of evidence-based mental health practices.

Improving the implementation and sustainment of evidence-based practices in community mental health organizations: a study protocol for a matched-pair cluster randomized pilot study of the Collaborative Organizational Approach to Selecting and Tailoring Implementation Strategies (COAST-IS)

BackgroundImplementing and sustaining evidence-based programs with fidelity may require multiple implementation strategies tailored to address multi-level, context-specific barriers and facilitators. Ideally, selecting and tailoring implementation strategies should be guided by theory, evidence, and input from relevant stakeholders; however, methods to guide the selection and tailoring of strategies are not well-developed. There is a need for more rigorous methods for assessing and prioritizing implementation determinants (barriers and facilitators) and linking implementation strategies to determinants. The Collaborative Organizational Approach to Selecting and Tailoring Implementation Strategies (COAST-IS) is an intervention designed to increase the effectiveness of evidence-based practice implementation and sustainment. COAST-IS will enable organizational leaders and clinicians to use Intervention Mapping to select and tailor implementation strategies to address their site-specific needs. Intervention Mapping is a multi-step process that incorporates theory, evidence, and stakeholder perspectives to ensure that implementation strategies effectively address key determinants of change.MethodsCOAST-IS will be piloted with community mental health organizations that are working to address the needs of children and youth who experience trauma-related emotional or behavioral difficulties by engaging in a learning collaborative to implement an evidence-based psychosocial intervention (trauma-focused cognitive behavioral therapy). Organizations will be matched and then randomized to participate in the learning collaborative only (control) or to receive additional support through COAST-IS. The primary aims of this study are to (1) assess the acceptability, appropriateness, feasibility, and perceived utility of COAST-IS; (2) evaluate the organizational stakeholders’ fidelity to the core elements of COAST-IS; and (3) demonstrate the feasibility of testing COAST-IS in a larger effectiveness trial.DiscussionCOAST-IS is a systematic method that integrates theory, evidence, and stakeholder perspectives to improve the effectiveness and precision of implementation strategies. If effective, COAST-IS has the potential to improve the implementation and sustainment of a wide range of evidence-based practices in mental health and other sectors.Trial registrationThis study was registered in ClinicalTrials.gov (NCT03799432) on January 10, 2019 (last updated August 5, 2019).

Usability Evaluation for Evidence-Based Psychosocial Interventions (USE-EBPI): A methodology for assessing complex intervention implementability.

Most evidence-based practices in mental health are complex psychosocial interventions, but little research has focused on assessing and addressing the characteristics of these interventions, such as design quality and packaging, that serve as intra-intervention determinants (i.e., barriers and facilitators) of implementation outcomes. Usability-the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction-is a key indicator of design quality. Drawing from the field of human-centered design, this article presents a novel methodology for evaluating the usability of complex psychosocial interventions and describes an example "use case" application to an exposure protocol for the treatment of anxiety disorders with one user group. The Usability Evaluation for Evidence-Based Psychosocial Interventions (USE-EBPI) methodology comprises four steps: (1) identify users for testing; (2) define and prioritize EBPI components (i.e., tasks and packaging); (3) plan and conduct the evaluation; and (4) organize and prioritize usability issues. In the example, clinicians were selected for testing from among the identified user groups of the exposure protocol (e.g., clients, system administrators). Clinicians with differing levels of experience with exposure therapies (novice, n =3; intermediate, n = 4; advanced, n = 3) were sampled. Usability evaluation included Intervention Usability Scale (IUS) ratings and individual user testing sessions with clinicians, and heuristic evaluations conducted by design experts. After testing, discrete usability issues were organized within the User Action Framework (UAF) and prioritized via independent ratings (1-3 scale) by members of the research team. Average IUS ratings (80.5; SD = 9.56 on a 100-point scale) indicated good usability and also room for improvement. Ratings for novice and intermediate participants were comparable (77.5), with higher ratings for advanced users (87.5). Heuristic evaluations suggested similar usability (mean overall rating = 7.33; SD = 0.58 on a 10-point scale). Testing with individual users revealed 13 distinct usability issues, which reflected all four phases of the UAF and a range of priority levels. Findings from the current study suggested the USE-EBPI is useful for evaluating the usability of complex psychosocial interventions and informing subsequent intervention redesign (in the context of broader development frameworks) to enhance implementation. Future research goals are discussed, which include applying USE-EBPI with a broader range of interventions and user groups (e.g., clients). Characteristics of evidence-based psychosocial interventions (EBPIs) that impact the extent to which they can be implemented in real world mental health service settings have received far less attention than the characteristics of individuals (e.g., clinicians) or settings (e.g., community mental health centers), where EBPI implementation occurs. No methods exist to evaluate the usability of EBPIs, which can be a critical barrier or facilitator of implementation success. The current article describes a new method, the Usability Evaluation for Evidence-Based Psychosocial Interventions (USE-EBPI), which uses techniques drawn from the field of human-centered design to evaluate EBPI usability. An example application to an intervention protocol for anxiety problems among adults is included to illustrate the value of the new approach.

The history, current status, and possible future of precision mental health

In evidence-based mental health practice, decisions must often be made for which there is little or no empirical basis. A common example of this is when there are multiple empirically supported interventions for a person with a given diagnosis, where the aim is to recommend the treatment most likely to be effective for that person. Data obtained from randomized clinical trials allow for the identification of patient characteristics that could be used to match patients to treatments. Historically, researchers have focused on individual moderators, single variables that interact statistically with treatment type, but these have rarely proved powerful enough to inform treatment decisions. Recently, researchers have begun to explore ways in which the use of multivariable algorithms might improve clinical decision-making. Common pitfalls have been identified, including the use of methods that provide overoptimistic estimates of the gains that can be expected from the applications of an algorithm in a clinical setting. It is too early to tell if these efforts will pay off and, if so, how much their use can increase the efficiency and effectiveness of mental health systems. It behooves the field to continue to learn and develop the most powerful methods that can produce generalizable knowledge that will advance the aims of precision mental health.

Implementing evidence-based mental health practices in schools: Feasibility of a coaching strategy

PurposeMood and anxiety disorders affect 20–30 percent of school-age children, contributing to academic failure, substance abuse, and adult psychopathology, with immense social and economic impact. These disorders are treatable, but only a fraction of students in need have access to evidence-based treatment practices (EBPs). Access could be substantially increased if school professionals were trained to identify students at risk and deliver EBPs in the context of school-based support services. However, current training for school professionals is largely ineffective because it lacks follow-up supported practice, an essential element for producing lasting behavioral change. The paper aims to discuss these issues.Design/methodology/approachIn this pilot feasibility study, the authors explored whether a coaching-based implementation strategy could be used to integrate common elements of evidence-based cognitive behavioral therapy (CBT) into schools. The strategy incorporated didactic training in CBT for school professionals followed by coaching from an expert during co-facilitation of CBT groups offered to students.FindingsIn total, 17 school professionals in nine high schools with significant cultural and socioe-conomic diversity participated, serving 105 students. School professionals were assessed for changes in confidence in CBT delivery, frequency of generalized use of CBT skills and attitudes about the utility of CBT for the school setting. Students were assessed for symptom improvement. The school professionals showed increased confidence in, utilization of, and attitudes toward CBT. Student participants showed significant reductions in depression and anxiety symptoms pre- to post-group.Originality/valueThese findings support the feasibility and potential impact of a coaching-based implementation strategy for school settings, as well as student symptom improvement associated with receipt of school-delivered CBT.

Economic evaluation in implementation science: Making the business case for implementation strategies

Implementation researchers have made notable progress in developing and testing implementation strategies (i.e., highly-specified methods used to help providers improve uptake of mental health evidence-based practices: EBPs). Yet, implementation strategies are not widely applied in healthcare organizations to improve delivery of EBPs. Economic considerations are a key factor influencing the use of implementation strategies to deliver and sustain mental health evidence-based practices, in part because many health care leaders are reluctant to invest in ongoing implementation strategy support without knowing the return-on-investment. Comparative economic evaluation of implementation strategies provides critical information for payers, policymakers, and providers to make informed decisions if specific strategies are an efficient use of scarce organizational resources. Currently, few implementation studies include implementation cost data and even fewer conduct comparative economic analyses of implementation strategies. This summary will introduce clinicians, researchers and other health professionals to the economic evaluation in implementation science. We provide an overview of different economic evaluation methods, discuss differences between economic evaluation in health services and implementation science. We also highlight approaches and frameworks to guide economic evaluation of implementation, provide an example for a cognitive-behavioral therapy program and discuss recommendations.

Introduction to the Special Issue on Emerging Adults, Part 1

"Introduction to the Special Issue on Emerging Adults, Part 1." Evidence-Based Practice in Child and Adolescent Mental Health, 4(2), pp. 103–104

A culturally grounded biopsychosocial assessment utilizing Indigenous ways of knowing with the Cowichan Tribes

ABSTRACTExtant research foregrounds the need for culturally responsive, evidence-based mental health practices when working with Indigenous communities. This study presents an Indigenous biopsychosocial assessment designed by members of the Cowichan Tribes to evaluate the social, developmental, and mental health histories of Cowichan youth. The assessment takes the form of an in-depth narrative interview whose parameters were developed through a culturally grounded, community-based process. This process supported a focus on relationality, interdependence, and intergenerational transmission of knowledge during the interview. Five participants ages 12 to 18 years completed interviews, which yielded sufficient data to enable completion of both Indigenous and standard biopsychosocial assessments.

The Mental Health Training Intervention for School Nurses and Other Health Providers in Schools.

School nurses encounter many students presenting with mental health needs. However, school nurses report that they need additional training and resources to be able to support student mental health. This study involved a multilevel, stakeholder-driven process to refine the Mental Health Training Intervention for Health Providers in Schools (MH-TIPS), an in-service training and implementation support system for school health providers, including school nurses, to increase their competence in addressing student mental health concerns. Findings highlighted the importance of mental health content including assessment, common factors of positive therapeutic mental health interactions, common elements of evidence-based mental health practice, and resource and referral mapping. Additionally, multifaceted ongoing professional development processes were indicated. Study findings indicate that, with recommended modifications, the MH-TIPS holds promise as a feasible, useful intervention to support school nurse practice and ultimately impact student mental health and educational outcomes.

Reforming the Portuguese mental health system: an incentive-based approach

BackgroundTo promote an effective mental health system, the World Health Organization recommends the involvement of primary care in prevention and treatment of mild diseases and community-based care for serious mental illnesses. Despite a prevalence of lifetime mental health disorders above 30%, Portugal is failing to achieve such recommendations. It was argued that this failure is partly due to inadequate financing mechanisms of mental health care providers. This study proposes an innovative payment model for mental health providers oriented toward incentivising best practices.MethodsWe performed a comprehensive review of healthcare providers’ payment schemes and their related incentives, and a narrative review of best practices in mental health prevention and care. We designed an alternative payment model, on the basis of the literature, and then we presented it individually, through face-to-face interviews, to a panel of 22 experts with different backgrounds and experience, and from southern and northern Portuguese regions, asking them to comment on the model and provide suggestions. Then, after a first round of interviews, we revised our model, which we presented to experts again for their approval, and provide new suggestions and comments, if deemed necessary. This approach is close to what is generally known as the Delphi technique, although it was not applied in a rigid way.ResultsWe designed a four-dimension model that focused on (i) the prevention of mental disorders early in life; (ii) the detection of mental disorders in childhood and adolescence; (iii) the implementation of a collaborative stepped care model for depression; and (iv) the integrated community-based care for patients with serious mental illnesses. First, we recommend a bundled payment to primary care practices for the follow-up of children with special needs or at risk under 2 years of age. Second, we propose a pay-for-performance scheme for all primary care practices, based on the number of users under 18 years old who are provided with check-up consultations. Third, we propose a pay-for-performance scheme for all primary care practices, based on the implementation of collaborative stepped care for depression. Finally, we propose a value-based risk-adjusted bundled payment for patients with serious mental illness.ConclusionsThe implementation of evidence-based best practices in mental health needs to be supported by adequate payment mechanisms. Our study shows that mental health experts, including decision makers, agree with using economic tools to support best practices, which were also consensual.

Correction to: The Effect of a Change Agent on Use of Evidence-Based Mental Health Practices.

The original version of this article unfortunately contained a mistake.

The impact of inter-organizational alignment (IOA) on implementation outcomes: evaluating unique and shared organizational influences in education sector mental health

BackgroundIntegrated healthcare delivered by work groups in nontraditional service settings is increasingly common, yet contemporary implementation frameworks typically assume a single organization—or organizational unit—within which system-level processes influence service quality and implementation success. Recent implementation frameworks predict that inter-organizational alignment (i.e., similarity in values, characteristics, activities related to implementation across organizations) may facilitate the implementation of evidence-based practices (EBP), but few studies have evaluated this premise. This study’s aims examine the impact of overlapping organizational contexts by evaluating the implementation contexts of externally employed mental health clinicians working in schools—the most common integrated service delivery setting for children and adolescents. Aim 1 is to estimate the effects of unique intra-organizational implementation contexts and combined inter-organizational alignment on implementation outcomes. Aim 2 is to examine the underlying mechanisms through which inter-organizational alignment facilitates or hinders EBP implementation.Methods/designThis study will conduct sequential, exploratory mixed-methods research to evaluate the intra- and inter-organizational implementation contexts of schools and the external community-based organizations that most often employ school-based mental health clinicians, as they relate to mental health EBP implementation. Aim 1 will involve quantitative surveys with school-based, externally-employed mental health clinicians, their supervisors, and proximal school-employed staff (total n = 120 participants) to estimate the effects of each organization’s general and implementation-specific organizational factors (e.g., climate, leadership) on implementation outcomes (fidelity, acceptability, appropriateness) and assess the moderating role of the degree of clinician embeddedness in the school setting. Aim 2 will explore the mechanisms through which inter-organizational alignment influences implementation outcomes by presenting the results of Aim 1 surveys to school-based clinicians (n = 30) and conducting semi-structured qualitative interviews. Qualitative data will be evaluated using an integrative inductive and deductive approach.DiscussionThe study aims are expected to identify intra- and inter-organizational constructs that are most instrumental to EBP implementation success in school-based integrated care settings and illuminate mechanisms that may account for the influence of inter-organizational alignment. In addition to improving school-based mental health, these findings will spur future implementation science that considers the relationships across organizations and optimize the capacity of implementation science to guide practice in increasingly complex systems of care.

Partnering With Black Churches to Increase Access to Care.

Partnering With Black Churches to Increase Access to Care.

Dissemination and Implementation of Evidence-Based Practices in Child and Adolescent Mental Health

Dissemination and Implementation of Evidence-Based Practices in Child and Adolescent Mental Health

Educator Perceptions of Preparedness and Professional Development for Implementation of Evidence-Based Practices Within a Multi-tiered System of Supports

A multi-tiered system of supports provides a framework for high-quality implementation of evidence-based mental health practices by educators so that all students have access to a continuum of mental health supports based on need. The purpose of this study was to use survey data to examine 700 educators’ perceptions of professional development and preparedness to implement mental health interventions within a multi-tiered system of supports. Descriptive analyses provided information about educator preparedness and access to training, resources, and coaching to support implementation of evidence-based mental health practices across tiers of supports. Further analyses revealed that access to training, resources, and coaching predicted preparedness to provide and assess mental health supports. Educators’ perceptions of student access to school and community mental health supports were predicted by access to training, resources, and coaching, and support for evidence-based practices. Perceived preparedness to provide mental health supports predicted whether or not educators reported talking with students about social or emotional concerns. Implications of the findings for professional development practices and policies within multi-tiered system of school-based mental health supports are discussed.

How Do Certified and Uncertified Therapists Differ in Their Perceptions of a Mental Health Intervention for ASD?

ABSTRACTGiven the increasing efforts to implement evidence-based practices (EBPs) in routine mental health (MH) services, it is necessary to examine MH therapists’ perspectives of the training and delivery process to better understand the outcomes of EBP implementation efforts and influences on these outcomes. However, there is limited research examining how therapists who successfully completed training and receive certification in an EBP intervention differ in their perceptions of these implementation outcomes and influences from those therapists who do not successfully complete training and receive certification in an intervention. As such, the present study examined variability in therapists’ perspectives in the training and implementation of the An Individualized Mental Health Intervention for ASD (AIM HI) intervention, a package of well-established, evidence-based strategies developed to address challenging behaviors in children with autism spectrum disorder within community MH clinics, based on training certification status (i.e. certified vs. noncertified). Overall, both certified and noncertified therapists perceived the AIM HI intervention as useful and effective with their clients, described the increased use of structure and improved clinical skills, and reported intended sustained use of parts of the AIM HI protocol. Conversely, certified and noncertified therapists differed in their approaches to addressing the perceived challenges of EBP training and implementation, specifically time commitment and program structure, providing valuable insight into why some therapists did not achieve certification status. These data support the development of organizational leadership and provider engagement interventions designed to address attitudinal and organizational barriers to facilitate the successful training and implementation of evidence-based interventions.

Training the Next Generation of School Psychologists to Deliver Evidence-Based Mental Health Practices: Current Challenges and Future Directions

School psychologists are uniquely positioned to support the delivery of evidence-based mental health practices (EBMHPs) to address the overwhelming mental health needs of children and youth. Gradua...

A practical protocol for situating evidence-based mental health programs and practices within school-wide positive behavioral interventions and supports

AbstractSchools have limited experience and little guidance to identify and install evidence-based and promising programs and practices/interventions (EBPs) within advanced tiers of School-Wide Positive Behavioral Intervention and Supports (SWPBIS). One form of guidance is the Hexagon Tool which can be used to ensure a match between the EBP and student needs. The authors demonstrate how the Hexagon Tool was utilized by an alternative education program already implementing SWPBIS. Data from the Hexagon Tool were used to identify and install EBPs for various student, faculty, and administrative needs. Outcomes related to installation of those EBPs, when applicable, are summarized. Based on these experiences, a hybrid protocol to equally ensure alignment of a given EBP to the developmental, cultural, and linguistic characteristics at the school was created. Schools are encouraged to use the Hexagon Tool or hybrid protocol in the process of implementing advanced tiers of support.

Using conjoint behavioral consultation to implement evidence-based practices for students in low-income urban schools

ABSTRACTThe purpose of this paper is to demonstrate how Conjoint Behavioral Consultation (CBC) can be used by school behavioral health programs within the Interactive Systems Framework (ISF) as a tool for developing and supporting intervention plans that integrate mental health evidence-based practices (EBPs). External behavioral health consultants trained and supported school personnel from two low-income urban K–8 schools in the implementation of CBC with EBPs employing ISF. Three cases highlight how the ISF can inform modifications to CBC to increase the fit between EBPs, urban school settings, and children living in low-income urban environments to implement with fidelity and produce positive outcomes. Case study data suggest that CBC can be used to support implementation of EBPs, and that interventions can be effective and acceptable.

Evidence-Based Mental Health Practices with Children Self-Efficacy Scale: Development and Preliminary Findings

ABSTRACTThis article reviews existing measures related to evidence-based practices with children and self-efficacy and describes the development and psychometric properties of the Evidence-Based Mental Health Practices With Children Efficacy Scale. This scale was developed to assess students’ and clinicians’ self-efficacy in their abilities to use evidence-based practices with children. Pre- and posttests were compared for five cohorts of master’s of social work students enrolled in a child and adolescent mental health course. Results provide initial support for the psychometric properties of this scale. Exploratory factor analysis results support retaining all items, and internal consistency of the scale was excellent. Results also provide support for criterion-related validity, with knowledge predicting an increase in self-efficacy. Implications and uses of the scale are discussed.