Evidence-based Treatment Practices Research Articles

Overview of Intellectual/Developmental Disabilities

Patients with intellectual/developmental disabilities (IDD) present many challenges to mental health professionals. The capacity to work with such patients requires a working knowledge of IDD as well as an awareness and understanding of the factors that affect the clinical presentation of mental health disorders across the spectrum of IDD.

Perceptions of the State Policy Environment and Adoption of Medications in the Treatment of Substance Use Disorders

Despite growing interest in the use of evidence-based treatment practices for treating substance use disorders, adoption of medications by treatment programs remains modest. Drawing on resource dependence and institutional theory, this study examined the relationships between adoption of medications by treatment programs and their perceptions about the state policy environment. Data were collected through mailed surveys and telephone interviews with 250 administrators of publicly funded substance abuse treatment programs in the United States between 2009 and 2010. Multiple imputation and multivariate logistic regression were used to estimate the associations between perceptions of the state policy environment and the odds of adopting at least one medication for the treatment of substance use disorders. A total of 91 (37%) programs reported having prescribed any medication for treatment of a substance use disorder. Programs were significantly more likely to have adopted at least one medication if they perceived greater support for medications by the Single State Agency. The odds of adoption were significantly greater if the program was aware that at least one medication was included on their state's Medicaid formulary and that state-contract funding permitted the purchase of medications. States may play significant roles in promoting the adoption of medications, but adequate dissemination of information about state policies and priorities may be vital to further adoption. Future research should continue to study the relationships between the adoption of medications for treating substance use disorders and the evolving policy environment.

Training Community Mental Health Therapists to Deliver a Package of Evidence-Based Practice Strategies for School-Age Children with Autism Spectrum Disorders: A Pilot Study

Research on moving evidence-based practice (EBP) intervention strategies to community service settings for children with autism spectrum disorders (ASD) is urgently needed. The current pilot study addresses this need by examining the feasibility, acceptability and preliminary outcomes of training therapists practicing in community mental health (CMH) clinics to deliver a package of EBP strategies aimed to reduce challenging behaviors in school-age children with ASD. Results indicate that CMH therapists participated in both initial and ongoing training, were able to deliver the intervention with fidelity, and perceived the intervention strategies as useful. Parents participated in almost all sessions with their children and remained in therapy when therapists delivered the intervention. Meaningful reductions in child problem behaviors occurred over 5 months providing promising support for the intervention.

Evidence-Based Practice Principles

Clinicians providing psychiatric care are often faced with selecting interventions in areas of care for which there is limited scientific support, such as the information on traumatic stress responses and integrated care interventions. If they adhere to the principles of evidence-based practice (EBP), the lack of scientific support should not hamper clinicians from implementing the best EBP intervention. EBP interventions can be drawn from the literature provided clinicians accurately appraise the level of existing scientific knowledge. Regardless of the level of evidence, clinicians must discuss the recommended intervention, risks, benefits, and alternatives to achieve the best EBP outcome.

The power of multiple methods and evidence sources: Raising the profile of Canadian counselling psychology research.

In counselling psychology, research and practice are viewed as mutually informative, and Canadian counselling psychologists conduct research in a wide range of areas, utilizing a wide range of research methods. However, there are few Canadian publications that give prominence to counselling psychology scholarly work. Over the past decade, two trends have become more prominent in the practice of counselling psychology: evidence-based practice and outcome-focused intervention. Traditionally, empirical evidence for the efficacy of practice interventions has come from randomized controlled trials. This fails to reflect the diversity of methods and practice that Canadian counselling psychologists utilize. To address this discrepancy, in this article we provide some alternate ways for obtaining empirical support for the predictive efficacy of counselling interventions. We conclude by addressing some challenges currently facing counselling psychologists in Canada (i.e., publication venues, funding for research, the connection between research and practice, preparation of students) and describing some ways for raising the profile of counselling psychology research and practice in Canada. Keywords: Canadian counselling psychology research, evidence-based practice, research challenges, multiple methods research Research and practice are viewed as mutually informative and counselling psychologists conduct research in a wide range of areas, including those of the counselling relationship and other psychotherapeutic processes, the multicultural dimensions of psychology, and the roles of work and mental health in optimal functioning. Canadian counselling psychologists are especially concerned with culturally appropriate methods suitable for investigating both ernie and etic perspectives on human behaviour, and promote the use of research methods drawn from diverse epistemological perspectives, including innovative developments in qualitative and quantitative research. (Bedi et al., 20 11, p. 130) The preceding quotation, drawn from the comprehensive definition of counselling psychology adopted by the Canadian Psychological Association (CPA) in 2009, encapsulates the current state of scholarly practice in Canada, and hints at several issues that are confronting Canadian counselling psychology researchers today. In this article, we provide an in-depth discussion of three of these issues: (a) the diversity of methodologies that are employed by Canadian counselling psychology researchers, (b) the importance of connecting research and practice when considering the meaning of research evidence in a counselling psychology perspective, and (c) challenges associated with raising the profile of counselling psychology in Canada. Directions that we believe to be important for the discipline to pursue in the future are also discussed. First, however, it is important to obtain an understanding of the current state of research in our discipline. Canadian counselling psychologists have been engaged in conducting high quality research even before counselling psychology was established as a section within the Canadian Psychological Association 25 years ago. Counselling psychologists in Canada have contributed substantially to the literature on a wide range of subjects related to human development, psychological functioning, and practice, and have gained international renown in numerous areas, including research on career development (e.g., Cochran, 1997; Young et al, 2010), counselling processes (e.g., Bedi & Horvath, 2004; Horvath, & Luborsky, 1993), and immigration/ cultural contexts (e.g., Arthur & McMahon, 2005; McCormick, 1998; Samuda & Lewis, 1999). Moreover, the values that guide the definition of counselling psychology are evident in the research directions undertaken by counselling psychologists in Canada. Although researchers are engaged in examining the full range of phenomena that could be considered within the purview of counselling psychology, previous authors have identified several areas of particular strength for Canadian counselling psychology research. …

Barriers to implementation of evidence-based addiction treatment: A national study

Prior studies have identified that working in an addiction treatment unit with higher levels of organizational capacity is a factor associated with positive staff attitudes about evidence-based addiction treatment practices (EBPs). The study presented here explored whether staff perceptions about the organizational capacity of their treatment unit are also associated with staff experience of barriers to implementing EBPs. Multivariate regression methods examined the relationship between the clinical staff (n = 510) and director (n = 296) perceptions of organizational capacity (Texas Christian University Organizational Readiness for Change [TCU ORC]-staff and TCU ORC-director) and level of barriers experienced when implementing a new EBP controlling for a range of treatment unit characteristics, staff characteristics, and type of EBP implemented. For both samples, reporting higher levels of stress in their organizations was significantly associated with reporting higher levels of barriers when implementing a new EBP. For clinical staff only, experiencing lower levels of program needs in their organization, working in a program that had been in existence for a shorter period, and implementing motivational interviewing techniques compared with other EBPs were all factors significantly associated with experiencing lower levels of barriers with EBP implementation.

228 Pain Medications Available in the Emergency Departments of a Rural State

228 Pain Medications Available in the Emergency Departments of a Rural State

Evidence-Based Substance Abuse Treatment for Adolescents: Engagement and Outcomes

Over the past decade the empirical foundation which supports the use of evidence-based practices in adolescent substance abuse treatment has increased significantly. However, there remains a gap in the literature regarding the effectiveness of utilising assertive methods for re-engaging adolescents that leave treatment early or providing continuing care following treatment. This paper helps to fill this gap by (1) describing the Assertive Adolescent Family Treatment (AAFT) initiative funded to replicate the implementation of the Adolescent Community Reinforcement Approach (A-CRA) followed by Assertive Continuing Care (ACC); (2) discussing the primary components of A-CRA and ACC (e.g., number of sessions, therapeutic content) and the implementation strategies employed in an adolescent outpatient treatment setting in the Southwestern United States (e.g., personnel, training, fidelity monitoring); (3) describing a sample of 144 adolescent participants between the ages of 12 and 17 years old that received A-CRA and/or ACC; and (4) examining differential effects of A-CRA and ACC on key outcomes. The article concludes with a discussion of the practical implications and applications for social work practice.

Factors Associated with Critical Thinking Abilities in Psychotherapists

Critical thinking is assumed to be an important factor in the promotion of evidence-based treatment practices. However, little is known about attitudinal and other dispositional factors that may influence critical thinking in psychotherapists specifically. The aim of the current study was to identify factors associated with critical thinking abilities in psychotherapists. A total of 143 licensed psychotherapists completed an Internet-based survey that assessed their critical thinking ability. Hierarchical regression analyses indicated that critical thinking ability was associated with theoretical orientation, reliance on intuition in decision-making, and endorsement of erroneous beliefs about health. Implications for improving critical thinking skills in psychotherapists are discussed.

Effectiveness of the tailored EBP training program for Filipino physiotherapists: A randomised controlled trial

AstractBackgroundEvidence implementation continues to challenge health professionals most especially those from developing countries. Filipino physiotherapists represent a group of health professionals in a developing country who by tradition and historical practice, take direction from a doctor, on treatment options. Lack of autonomy in decision-making challenges their capacity to deliver evidence-based care. However, this scenario should not limit them from updating and up-skilling themselves on evidence- based practice (EBP). EBP training tailored to their needs and practice was developed to address this gap. This study will be conducted to assess the effectiveness of a tailored EBP-training program for Filipino physiotherapists, in improving knowledge, skills, attitudes and behaviour to EBP. Participation in this program aims to improve capacity to EBP and engage with referring doctors to determine the most effective treatments for their patients.Methods/DesignA double blind randomised controlled trial, assessing the effectiveness of the EBP training intervention, compared with a waitlist control, will be conducted. An adequately powered sample of 54 physiotherapists from the Philippines will be recruited and randomly allocated to EBP intervention or waitlist control.Intervention: The EBP program for Filipino physiotherapists is a one-day program on EBP principles and techniques, delivered using effective adult education strategies. It consists of lectures and practical workshops. A novel component in this program is the specially-developed recommendation form, which participants can use after completing their training, to assist them to negotiate with referring doctors regarding evidence-based treatment choices for their patients.Pre and post measures of EBP knowledge, skills and attitudes will be assessed in both groups using the Adapted Fresno Test and the Questions to EBP attitudes. Behaviour to EBP will be measured using activity diaries for a period of three months.DiscussionShould the EBP-training program be found to be effective in improving EBP-uptake in Filipino physiotherapists, it will form the basis of a much needed national intervention which is contextually appropriate to Filipino physiotherapists. It will therefore form the genesis for a model for building EBP capacity of other health professionals in the Philippines as well as physiotherapists in developing countries.Trial RegistrationCurrent Controlled Trials: ISRCTN74485061

Investigating Adherence Promoters in Evidence-Based Mental Health Interventions with Children and Adolescents

The effectiveness of Evidence-Based Practice (EBP) interventions in child and adolescent mental health is undermined by poor client adherence to treatment protocols. To counter this trend, adherence promoters, supplemental interventions to facilitate client adherence to treatment protocols, have evolved to increase adherence. This study investigates patterns of adherence promoting interventions employed in conjunction with RCT of interventions for child and adolescent mental health problems. An 85 question survey on adherence promoters was sent to 85 researchers who published randomized controlled trials on three psychosocial interventions (Cognitive Behavioral Therapies (CBT), Interpersonal Therapy (IPT), and Psychoeducational (PE)) in the area of child and adolescent mental health, between January 2000 and March 31, 2008. Forty-six (54%) researchers completed the survey. Most researchers reported using multiple adherence promoting interventions throughout the duration of their studies. The intensity of adherence promoting efforts was increased for interventions targeting disruptive behavior disorders and for family based interventions. On average, respondents reported using little more than one promoter per session and devoting approximately 12min per session on all adherence promoters. Clinical researchers expend considerable resources in active efforts to promote adherence to treatment among research participants. Findings of this study support best practice literature on adherence promotion and open new avenues for research into the adherence to evidence-based interventions for child and adolescent mental health problems.

Training research: practical recommendations for maximum impact.

This review offers practical recommendations regarding research on training in evidence-based practices for mental health and substance abuse treatment. When designing training research, we recommend: (a) aligning with the larger dissemination and implementation literature to consider contextual variables and clearly defining terminology, (b) critically examining the implicit assumptions underlying the stage model of psychotherapy development, (c) incorporating research methods from other disciplines that embrace the principles of formative evaluation and iterative review, and (d) thinking about how technology can be used to take training to scale throughout all stages of a training research project. An example demonstrates the implementation of these recommendations.

P03-138 - Improving child and adolescent adherence to evidence-based mental health interventions

IntroductionThe exponential growth of evidence-based practice (EBP) interventions offers clinicians a growing number of empirically-supported psychosocial treatments for youth mental disorders. These interventions are likely to be ineffective with clients who drop out of treatment prematurely or who fail to adhere to the required intervention protocols. However, despite the critical role of client adherence, systematic evidence about strategies to support client adherence is lacking.ObjectivesThe primary aim of this present study is to establish an empirical base for developing adjunctive adherence promoters to enhance client participation in psychosocial interventions.MethodsMental health child and adolescent intervention researchers who published RCT on three psychosocial interventions (CBT, IPT. Psycho-ed) were surveyed on type, use, and efficacy of intervention adherence promoters.ResultsInterventions included an average of 13.4 sessions (SD = 7.8) across 5 months. Most researchers reported using multiple adherence promoting interventions throughout their studies. On average, respondents reported using little more than one promoter per session and devoting approximately 12.4 minutes per session on all adherence promoters.ConclusionsResults of this study will assist practitioners and researchers in improving adherence to psychiatric interventions for children and adolescents. Specifically, study results fill gaps in the literature on active efforts to sustain and increase client adherence to treatment for childhood and adolescent mental health disorders. Findings of this study support best practices for adherence promotion and open new avenues for research into the tailoring of adherence to EBP interventions for child and adolescent mental health problems.

Community-based addiction treatment staff attitudes about the usefulness of evidence-based addiction treatment and CBO organizational linkages to research institutions

This national study of community-based addiction-treatment organizations’ (CBOs) implementation of evidence-based practices explored CBO Program Directors’ ( n = 296) and clinical staff ( n = 518) attitudes about the usefulness of science-based addiction treatment. Through multivariable regression modeling, the study identified that identical factors were associated with directors, and staff attitudes about the usefulness of science-based addiction treatment. For both directors and staff working in an organization that was affiliated with a research institution, working in an organization with better internet technology (measured through TCU-ORC scores) and having higher levels of education were all significantly associated with having more positive attitudes regarding science-based addiction treatment. Implications: government policy that promotes the hiring of addiction treatment clinical staff with professional degrees and encourages the development of linkages between addiction treatment researchers and treatment staff may positively impact attitudes and use of evidence-based addiction treatment practices (EBPs) in CBOs.

Barriers to the implementation of medication-assisted treatment for substance use disorders: The importance of funding policies and medical infrastructure

Despite growing interest in the use of evidence-based treatment practices, adoption of pharmacotherapies for treating substance use disorders (SUDs) remains modest. Using data from telephone interviews with 250 administrators of publicly funded SUD treatment programs, this study estimated a model of adoption of medication assisted treatment (MAT) for SUDs and examined the relative importance of regulatory, cultural, medical resource, patient-level, and funding barriers to MAT implementation. MAT-adopting programs had significantly greater medical resources, as measured by the employment of physicians and nurses, than non-adopting programs. Administrators of non-adopting programs were asked to rate the importance of 18 barriers to MAT implementation. The most strongly endorsed barriers were regulatory prohibitions due to the program's lack of medical staff, funding barriers to implementing MAT, and lack of access to medical personnel with expertise in delivering MAT. Barriers related to insufficient information about MAT and unsupportive staff attitudes were not widely endorsed. These findings suggest that efforts to promote the implementation of MAT that are inattentive to funding barriers and weaknesses in medical infrastructure may achieve sub-optimal results.

The Trauma of Torture and the Rehabilitation of Torture Survivors

The aim of torture is to cause severe pain and suffering in order to destroy the structure of the personality and the identity of the victim. Torture is applied in over a 100 countries worldwide, and its consequences affect millions of survivors. The rehabilitation of those who have experienced torture is a lengthy and complex process; treatment centers all over the world are constantly developing their methods to assist the mental and physical healing of torture survivors. The present article offers insights into the nature of torture, applied torture techniques, the psychological sequelae of torture, and diagnostic developments. Furthermore, current issues of rehabilitation and reparation are discussed, including the debate on evidence-based practice in treatment. The aim of the authors is to offer a brief but comprehensive review on torture and rehabilitation for professionals of mental health care and other relevant fields.

Total Quality Management and Performance in Substance Abuse Treatment Centers

To examine the relationship of organizational characteristics of substance abuse treatment centers with their use of quality management practices (total quality management [TQM]) and the contribution of TQM use to a center's provision of comprehensive care and to use of evidence-based treatment practices. Data were collected from a national sample of over 700 private and public substance abuse treatment centers in the National Treatment Center Study. The design was a cross-sectional field study. The key variables were three TQM practices, the provision of comprehensive treatment services, and the implementation of evidence-based treatment practices. Numerous organizational characteristics were controlled. The data were obtained through interviews with administrative directors and clinical directors of the treatment centers in 2002-2004. In multivariate models, TQM practices were positively related to provision of comprehensive care and use of evidence-based practices. A limited set of organizational characteristics predicted the use of TQM practices. Substance abuse treatment centers' implementation of TQM processes may be positively related to the quality and cost-effectiveness of care provided.

Methodological Issues in Child Welfare and Children’s Mental Health Implementation Research

Methodological Issues in Child Welfare and Children’s Mental Health Implementation Research

Sustained Improvement in Pediatricians' ADHD Practice Behaviors in the Context of a Community-Based Quality Improvement Initiative

The long-term sustainability of a quality improvement project was examined. The ADHD Collaborative was designed to assist community-based pediatricians in adhering to the American Academy of Pediatrics evidence-based assessment and treatment guidelines for attention deficit hyperactivity disorder (ADHD). Patient chart reviews were completed out to 2 years post training for 14 practices (N = 38 pediatricians), who received the ADHD Collaborative intervention to assess whether improvements made immediately post training were sustained. Pediatricians maintained significant improvements in their use of evidence-based assessment and treatment practices for a period of 2 years. The majority of the improvements occurred quickly, within 6 months of training. Pediatricians focused most of their continuous quality improvement (CQI) efforts on improving follow-up care for their patients with ADHD. Systematic monitoring and follow up of ADHD patients who were prescribed medication improved considerably from pre-training (10%) to 6 months (49%), and pediatricians continued to make gradual improvements in follow-up care (62% at the 2-year follow up). Systematic intervention efforts with a focus on CQI are effective at improving and sustaining quality of ADHD care. More work is needed to determine how to disseminate, support, and deliver this and similar intervention models to the many physicians who may benefit.

Adoption of Medications in Substance Abuse Treatment: Priorities and Strategies of Single State Authorities

Research has confirmed the effectiveness of medications, when used in conjunction with ongoing counseling, to treat substance abuse disorders. This article describes a national, mixed-methods research project designed to investigate single state authorities' (SSAs) perceptions of adoption of evidence-based practices in substance abuse treatment. Results are focused specifically on medication-assisted treatment, one of five evidence-based practices defined by the National Quality Forum. Medication-assisted treatment (MAT) is an important and effective part of comprehensive care options available to clients who are chronically ill with alcohol and other drug disorders. Despite mounting clinical evidence and increased availability, overall rates of implementation and sustained adoption of medications to treat addiction remain limited. The results illustrate that the SSA representatives who fund public treatment programs believe MAT is a priority and worthy of system-wide implementation. Current strategies utilized by SSAs to support the adoption of MAT are detailed, as are barriers to adoption and implementation.