Practice Research Networks Research Articles

Intake Characteristics as Predictors of Psychotherapy Outcome in a Practice Research Network in Argentina

There are few studies exploring intake diagnostic characteristics as predictors of change in integrative naturalistic settings. The aim of this study is to explore baseline variables at the intake process and establish the predictive value of the individual trajectories of the patients. We recruited 259 patients undergoing an integrative psychotherapy network of psychotherapists from Buenos Aires, Argentina. Every therapist completed the intake form of each patient involved in the routine outcome monitoring. Thereafter step-wise regressions based on forward selection strategies were used, in order to identify meaningful baseline predictors of patients’ clinical evolution, derived from the intake process. The selected predictors were social support network, subjective distress, the initial measure of clinical distress, unemployment, sociocultural status and reactance. When including those six variables in a multilevel model, the results indicate that social support network, subjective distress, and the initial measure of clinical distress were significant predictors of the trajectories of OQ-30, whereas unemployment, sociocultural status and reactance were not significant. The results regarding social support network are in line with the literature, while results of socioeconomic status (unemployment and sociocultural level) move in an opposite direction in comparison to the available evidence. Moreover, the mental health findings (initial OQ-30 and subjective distress) confirm the contradictory body of literature produced in this domain. Finally, reactance seems to be a significant predictor in previous study in contradiction of our results. Overall, this endeavor constitutes important but preliminary evidence to enhance the production of bottom-up science within practice research networks in the global south.

The Promise and Challenges of Practice-Oriented Research: A Commentary on the Special Issue.

At the centre of POR is the concept of collaboration between patients, therapists, agencies, and third-party payers. For this commentary, I review the articles of the special issue with attention to both the opportunities and challenges offered by practice-oriented research (POR).I also reviewed some previous research on practice-research networks and how that research might inform POR. The use of routine outcome monitoring (ROM), artificial intelligence (AI), and program evaluation (PE) models show promise for advancing POR. However, each comes with its challenges. The use of ROM to improve patient outcomes has research support. However, researchers have identified problems with implementing ROM because of low uptake by clinicians and because clinicians may see ROM as a potential intrusion. AI shows promise to improve patient outcomes by potentially providing therapists with immediate and nuanced data to inform interventions and interpersonal stances specific to each patient. However, the scaling up of AI runs the risk of dehumanizing psychological interventions. PE may provide a context for allowing therapists to engage in POR to address real-world processes and outcomes of mental health interventions. However, like ROM PE faces the challenge of trust among clinicians and patients who may be reluctant to participate. Despite these challenges, and because of efforts to nurture and maintain respectful collaborations, articles in this special issue highlight how POR can play a pivotal role in bridging the gap between theory and practice.

Integrating learners into research and quality improvement projects: A joint opinion of the Adult Medicine and Education and Training Practice Research Networks of the American College of Clinical Pharmacy

AbstractResearch plays a vital role in advancing the pharmacy profession and improving patient care. It is a fundamental skill for learners to develop during their training under guided mentorship. Incorporating learners into research and quality improvement (QI) projects can yield numerous benefits for the learner, mentor, and institution. Despite this, there are barriers to integrating learners into research and QI projects which may stem from institutions and individuals. To ensure success when engaging in the research process, strategies centered around clear communication and illustrating the value should be implemented. Successful research programs require planning strategically, setting clear expectations, providing mentorship, and remaining adaptable to overcome barriers encountered during the process. The purpose of this paper is to discuss barriers to incorporating learners into research and QI projects and provide both mentors and learners strategies, tips and examples for success with perspectives and opinions from the American College of Clinical Pharmacy Adult Medicine and Education and Training Practice Research Networks.

Patterns of psychotropic drug prescriptions and general practice consultations among community-dwelling older people with dementia during the first two years of the COVID-19 pandemic

BackgroundThe COVID-19 pandemic and subsequent lockdown measures had serious implications for community-dwelling older people with dementia. While the short-term impacts of the pandemic on this population have been well studied, there is limited research on its long-term impacts. Quantifying the long-term impacts may provide insights into whether healthcare adaptations are needed after the acute phase of the pandemic to balance infection prevention measures with healthcare provision. This study aims to examine patterns of psychotropic drug prescriptions and general practice consultations in community-dwelling older people with dementia during the first two years of the pandemic.MethodsWe utilised routine electronic health records from three Dutch academic general practice research networks located in the North, East, and South, between 2019 and 2021. We (1) compared the weekly prescription rates of five groups of psychotropic drugs and two groups of tracer drugs, and weekly general practice consultation rates per 1000 participants, between the first two years of the pandemic and the pre-pandemic phase, (2) calculated changes in these rates during three lockdowns and two relaxation phases relative to the corresponding weeks in 2019, and (3) employed interrupted time series analyses for the prescription rates. Analyses were performed for each region separately.ResultsThe study population sizes in the North, East, and South between 2019 and 2021 were 1726 to 1916, 93 to 117, and 904 to 960, respectively. Data from the East was excluded from the statistical analyses due to the limited sample size. During the first two years of the pandemic, the prescription rates of psychotropic drugs were either lower or similar to those in the pre-pandemic phase, with differences varying from -2.6‰ to -10.2‰. In contrast, consultation rates during the pandemic were higher than in the pre-pandemic phase, increasing by around 38‰.ConclusionsThis study demonstrates a decrease in psychotropic drug prescriptions, but an increase in general practice consultations among community-dwelling older people with dementia during the first two years of the pandemic. However, reasons for the decrease in psychotropic drug prescriptions are unclear due to limited information on the presence of neuropsychiatric symptoms and the appropriateness of prescribing.

Gaps between Supply and Utilization of Social Work Evidence in Mainland of China

Purpose: The comparison research involving two studies aimed to explore the gap between social work evidence production and utilization in Mainland of China. Methods: Study 1 was a scoping review to screen qualified publications in the Web of Science Core Collection. Study 2 conducted correlation analysis and an analysis of variance using the data from the China Social Work Longitudinal Study 2019. Results: In Study 1, 745 publications from 35 main social work journals represented the overall improving volume and quality of evidence in Mainland of China. Study 2 showed a low intention to use evidence among the Chinese Mainland social work practitioners, which could be influenced by working region, years of work, educational level, work position, professional level, awareness of evidence-based practice (EBP), and willingness to learn EBP. Conclusions: An education gap, an intention gap, a regional development gap, and a time lag were identified between social work evidence supply and utilization in Mainland of China. Well-established education and training, as well as practice-research networks may be the solutions to bridge these gaps.

Development of a practice research network in Spain (Desarrollo de una red de investigación orientada por la práctica en España)

ABSTRACT The purpose of practice research networks is to foster clinically relevant research and scientifically informed clinical practice. This article describes the development of a collaborative network between clinicians and researchers in Spain and Argentina. This network is made up of psychologists specialized in clinical psychology, intern resident psychologists who are members of the Spanish Society of Clinical Psychology and researchers working at different universities. The main aim of the network is to foster the development of practice research programmes in a collaborative manner. We present its first project that analyses the sociodemographic data, professional characteristics, personal style of therapists and their attitudes towards research of 409 Spanish clinical psychologists. This approach meant understanding clinicians’ interests, and the beginning of a collaborative interaction to create useful resources for clinical practice based on applied research.

Continuous quality improvement in measure development: Lessons from building a novel clinical feedback system

PurposeWhile the use of clinical feedback systems has become commonplace in psychological treatment, many of the most common instruments used for this purpose have not changed in decades. This paper describes the first four cycles of a measure development method designed to embrace continuous quality improvement.MethodsUsing techniques and philosophies developed in business management and academia—lean continuous quality improvement, action research, and practice research networks—we iterated through multiple cycles of development with the goal of creating an optimal clinical feedback system. These cycles emphasize building capacity to receive and implement feedback from a variety of stakeholders, especially patients and providers of behavioral health services, while also being responsive to quantitative findings from measure development.ResultsIterating measure development with stakeholder feedback over the course of 5 years has resulted in a novel measurement system with 19 subscales administered via branching logic, and a supporting practice research network to sustain development.ConclusionIn developing a new clinical feedback system, the less-frequently-discussed practical aspects of measure development require close attention. Specifically, being willing to embrace change, planning for iteration, and systematically seeking stakeholder feedback are identified as central methods for improving clinical feedback systems.

Evidencia basada en la práctica en psicoterapia: el reto en Latinoamérica

El artículo presenta una revisión teórica sobre el paradigma de la Práctica Basada en la Evidencia y sobre el de la Evidencia Basada en la Práctica en el ámbito de la psicoterapia; se profundiza especialmente en este último paradigma y su asociación con la investigación de la efectividad en psicoterapia. Posteriormente, se contextualiza el funcionamiento de este último paradigma en los sistemas de salud y en particular en la atención en salud mental, haciendo hincapié en su aplicabilidad en la evaluación rutinaria y su potencial para contribuir al campo de la investigación en psicoterapia. Finalmente, se presentan algunas conclusiones sobre cómo promover la investigación orientada a la Evidencia Basada en la Práctica en contextos psicoterapéuticos, a partir de Redes de Investigación en la Práctica en los países latinoamericanos.

Toward a personalized approach to psychotherapy outcome and the study of therapeutic change.

Toward a personalized approach to psychotherapy outcome and the study of therapeutic change.

The International Pharmacists-as-Immunizers Partnership (IPIP)-Advancing Research on Pharmacist-Administered Immunizations Worldwide.

This article describes the formation of the International Pharmacists-as-Immunizers Partnership (IPIP), an international network of pharmacy practice researchers with an interest in pharmacist-administered immunizations. Using funds obtained from a university-sponsored grant, a two-day meeting was held at the University of Waterloo in Canada to discuss published and in-progress research on the topic, identify gaps and priorities for future research, and share implementation strategies used in different jurisdictions. Twelve researchers from five countries attended this initial meeting, identified from both personal networks and from authorship lists from published research. Small- and large-group discussions addressed a number of themes, including: clinical, economic and educational outcomes of the service; the perspectives of pharmacists, patients, and other health professionals; operational and policy factors influencing uptake; safety; and the immunizing pharmacist’s role in disaster preparedness. Feedback on our first meeting and outcomes achieved were evaluated on the basis of participant feedback. Key components of the meeting that were considered successful and important lessons learned are summarized, so that other like-minded researchers with a shared pharmacy practice research interest could consider leveraging funding opportunities to establish other international pharmacy practice research networks.

The values and self‐efficacy beliefs of postgraduate psychology students

ObjectivePostgraduate psychology students must develop three generic capabilities: theory, research, and communication. This is critical to strengthen the link between science and practice. The current study explored the impact of students’ postgraduate program on task values and self‐efficacy beliefs using an expectancy‐value perspective.MethodTwo hundred and thirty‐seven postgraduate psychology students (195 females, Mage = 30.98, standard deviation = 8.34) completed a survey investigating student values and expectations. Students were enrolled in a Master of Psychology (n = 90), research‐only PhD (n = 72), or professional doctorate/Masters with PhD (n = 75).ResultsA series of 3 (Domain) × 3 (Program) mixed factorial analysis of variances were conducted to explore postgraduates’ social influences, task values, and self‐efficacy beliefs towards theory, research, and communication. Coursework students perceived peers to value communication skills significantly more than research, while research‐only students perceived peers to value theory, research, and communication equally. Postgraduate students in all programs reported consistently lower task values and self‐efficacy beliefs towards the research domain.ConclusionAustralian universities and professional organisations are encouraged to support the development of practice–research networks to facilitate greater collaboration and stronger links between future psychological scientists and practitioners.

The Role of Practice Research Networks (PRN) in the Development and Implementation of Evidence: The Northern Improving Access to Psychological Therapies PRN Case Study

Practice research networks (PRNs) can support the implementation of evidence based practice in routine services and generate practice based evidence. This paper describes the structure, processes and learning from a new PRN in the Improving Access to Psychological Therapies programme in England, in relation to an implementation framework and using one study as a case example. Challenges related to: ethics and governance processes; communications with multiple stakeholders; competing time pressures and linking outcome data. Enablers included: early tangible outputs and impact; a collaborative approach; engaging with local research leads; clarity of processes; effective dissemination; and committed leadership.

Practical clinical trials in psychopharmacology: a systematic review.

Practical clinical trials (PCTs) are randomized experiments under typical practice conditions with the aim of testing the "real-life" benefits and risks of therapeutic interventions. Influential PCTs have been conducted in cardiology, oncology, and internal medicine. Psychotropic medications are widely and increasingly used in medical practice. This review examines recent progress in conducting PCTs in psychopharmacology. The January 2000 to October 2014 MEDLINE, Scopus, and ClinicalTrials.gov databases were searched for peer-reviewed publications of PCTs with at least 100 subjects per treatment arm. Most PCTs in psychiatry evaluated mental health services or psychosocial interventions rather than specific pharmacotherapies. Of 157 PCTs in psychiatry, 30 (19%) were in psychopharmacology, with a median of 2 publications per year and no increase during the period of observation. Sample size ranged from 200 to 18,154; only 11 studies randomized 500 patients or more. Psychopharmacology PCTs were equally likely to be funded by industry as by public agencies. There were 10 PCTs of antidepressants, for a total of 4206 patients (in comparison with at least 46 PCTs of antihypertensive medications, for a total of 208,014 patients). Some psychopharmacology PCTs used suicidal behavior, treatment discontinuation, or mortality as primary outcome and produced effectiveness and safety data that have influenced both practice guidelines and regulatory decisions. Practical clinical trials can constitute an important source of information for clinicians, patients, regulators, and policy makers but have been relatively underused in psychopharmacology. Electronic medical records and integrated practice research networks offer promising platforms for a more efficient conduct of PCTs.

What clinicians want: findings from a psychotherapy practice research network survey.

Practice research networks may be one way of advancing knowledge translation and exchange (KTE) in psychotherapy. In this study, we document this process by first asking clinicians what they want from psychotherapy research. Eighty-two psychotherapists in 10 focus groups identified and discussed psychotherapy research topics relevant to their practices. An analysis of these discussions led to the development of 41 survey items. In an online survey, 1,019 participants, mostly practicing clinicians, rated the importance to their clinical work of these 41 psychotherapy research topics. Ratings were reduced using a principal components analysis in which 9 psychotherapy research themes emerged, accounting for 60.66% of the variance. Two postsurvey focus groups of clinicians (N = 22) aided in interpreting the findings. The ranking of research themes from most to least important were-Therapeutic Relationship/Mechanisms of Change, Therapist Factors, Training and Professional Development, Client Factors, Barriers and Stigma, Technology and Adjunctive Interventions, Progress Monitoring, Matching Clients to Therapist or Therapy, and Treatment Manuals. Few differences were noted in rankings based on participant age or primary therapeutic orientation. Postsurvey focus group participants were not surprised by the top-rated items, as they were considered most proximal and relevant to therapists and their work with clients during therapy sessions. Lower ranked items may be perceived as externally imposed agendas on the therapist and therapy. We discuss practice research networks as a means of creating new collaborations consistent with KTE goals. Findings of this study can help to direct practitioner-researcher collaborations.

Population-based initiatives in college mental health: students helping students to overcome obstacles.

College students' need for mental health care has increased dramatically, leaving campus counseling and mental health centers struggling to meet the demand. This has led to the investigation and development of extra-center, population-based interventions. Student-to-student support programs are but one example. Students themselves are a plentiful, often-untapped resource that extends the reach of mental health services on campus. Student-to-student programs capitalize on students' natural inclination to assist their peers. A brief review of the prevalence and effects of mental disorders in the college population is provided, followed by a broad overview of the range of peer-to-peer programs that can be available on college campuses. Two innovative programs are highlighted: (1) a hospital- and community-based program, the College Mental Health Program (CMHP) at McLean Hospital, and 2) the Student Support Network (SSN) at Worcester Polytechnic Institute. The subsequent section reviews the literature on peer-to-peer programs for students with serious and persistent mental illness for which there is a small but generally positive body of research. This lack of an empirical basis in college mental health leads the authors to argue for development of broad practice-research networks.

The Art Therapy Practice Research Network: Hurdles, pitfalls and achievements

Aim: This article gives an overview of the setting up of the Art Therapy Practice Research Network (ATPRN) in 2000, amidst a culture resistant to research. The authors discuss their experiences in changing this culture and encouraging art therapists to become practitioner/researchers. They identify learning points that may be helpful for other professionals who want to form new practice research networks (PRNs). Context: The research and practice context contemporary to the ATPRN foundation is outlined and identified as a significant influence on its inception and development. Key events in the 14 years of the PRN's life and articles on art therapy and psychotherapy research published at the time of the ATPRN foundation are used to illuminate the historical context. ATPRN newsletters and symposium reports were consulted to identify themes and issues across 14 years of development and growth. Learning points: Several learning points are identified and listed as useful factors to address when setting up and maintaining a PRN and include: shape the culture from the start; review and revise; get practical together; encourage members' presentations; build synergy with professional body; embed the ATPRN around all aspects of research publication. Conclusions: Successful PRNs depend on making practitioners feel included from the start by acknowledging fear and anxiety about research. Providing practical projects helped practitioners to feel less isolated by being part of a meaningful and productive network. Maintaining and developing PRNs is an iterative process that demands constant reviewing and revising.

Family Inclusive Child Protection Practice: The Need for Rigorous Evaluation

Historical and current child protection practice in Australia has been subject to severe criticism, yet in spite of a persuasive case for an alternative family inclusive form of child protection practice – something that offers the potential for improved client outcomes and improved worker job satisfaction – the model is not yet in widespread use. An international review of promising innovations in child protection, including examples of programmes from Australia, resulted in a list of eight identified trends. Common to all of these trends was evidence that good-quality evaluation had contributed to their recognition. If family inclusive practice is to gain greater acceptance, especially by bureaucrats, policy makers and holders of the purse strings, sophisticated forms of programme evaluation will be required. Such evaluations might emphasise practice-based research where researchers and frontline practitioners work together on all aspects of evaluation, including the initial design stage. While gold-standard randomised controlled trials may be included, methodological pluralism should allow inclusion of alternative approaches, such as realist evaluation and the involvement of practice research networks. The use of external evaluators might be usefully replaced with greater reliance on evaluation partnerships between evaluation experts (researchers) and frontline agency staff. Follow-up systematic reviews and meta-analyses might then allow the development of evidence-based arguments for change. Some Australian programmes have shown how rigorous evaluation practices have underpinned success and this evaluation focus could be emulated.

Cognitive analytic therapy: A review of the outcome evidence base for treatment

This study reviews the quality of the extant outcome evidence for cognitive analytic therapy (CAT) to inform clinical practice and to stimulate a future CAT research strategy. An electronic search identified CAT efficacy and effectiveness studies and these were subject to systematic review. The methodological quality of studies meeting inclusion criteria were appraised using two validated research study quality checklists and studies were fitted to an established model of psychotherapy evaluation. Twenty-five outcome studies met the inclusion criteria, including five randomized controlled trials. The CAT evidence base is predominated by small-scale practice-based studies, in typically complex and severe clinical populations - 44% were focal to the treatment of personality disorder. Although the quality of extant CAT evidence is generally sound (52% of studies were high quality), the depth and breadth of the evidence base is currently limited. Where comparisons with other modalities are available, CAT appears largely equivocal. Cognitive analytic therapy is a popular and promising intervention for complex presentations. However, the evidence base currently lacks wider credibility due to having largely bypassed the rigours of the controlled phase of the hourglass model of psychotherapy evaluation. There is a particular need for further CAT outcome research with common mental health problems. CAT can be an effective intervention across a range of mental health difficulties. Consider a 24-session CAT contract for those patients presenting with complex and severe difficulties. Practice research networks could make a significant contribution to the CAT evidence base.

Approches psychothérapiques de l’autisme. Résultats préliminaires à partir de 50 études intensives de cas

BackgroundSince the 2000s, the evaluative psychotherapy research has refocused on the questions “Why, how and under what conditions psychotherapy works?”. These objectives involve giving prominence to pragmatic naturalistic case studies and practice research networks to achieve them. This article presents the first results of a multicenter longitudinal process-outcome study, during one year, of individual psychotherapies conducted under natural conditions with children with autism, in the context of the Inserm Psychotherapy Practice-Based Research Network. MethodsThe general methodology is the intensive study of individual cases meeting the criteria for evidence of the American Psychological Association. The indicators include the one hand symptoms, the process of development and mental functioning and secondly the therapeutic action from the main characteristics of the patient, the therapist and their interactions during therapy. The analysis combines and connects the study of each case, the cases together and comparing similar cases. This article focuses on the results from the 50 first aggregated cases (25 psychotherapies of children under the age of 6years and 25 aged 7–15years). ResultsAnalysis of aggregated cases show significant changes in the reduction of behavioural disorders (effect size=2.1; P<0.0001), development (effect size=1.2; P<0.0001), emotional experience and relationships to the world and others. The psychotherapeutic process is characterized by a generally active and animated child, and a responsive and sensitive therapist, adjusting to the child, encouraging him to express himself verbally, supporting its attempts to language, while having a great capacity for tolerance with emotions and violent impulses of the child and keeping him in countenance. This description leads to the hypothesis of 4 main causes that may explain the evolution of children: the therapeutic setting, the adjustment of therapist to the child, his/her tolerance opening the possibility of affects’ expression, and the parallel work of verbalization/symbolization. ConclusionsOur results support the notion that psychotherapy conducted under natural conditions by experienced and trained in the specificity of autism practitioners, is associated with significant changes. The results also suggest that underlining mechanisms might be favourable conditions for the initiatives of the child, expression and mutual understanding as a basis for enhancement of communication and language, and structuration of the Self. The limitations of these preliminary results are discussed and targets for reducing presented.

Trainee Prize Award Winner Practice-based research and counselling psychology: A critical review and proposal

Content and FocusThis narrative literature review critically considers the relationship between practice-based research and counselling psychology. Its starting-point is contexts where gaps between psychotherapy research and practice have been identified. Developments in practice-based research, and the extent to which counselling psychology appears engaged in these, are then explored. Contexts in which practice-based research is conducted are considered, with particular focus on the practice-research network. The challenges associated with practice-research networks, in particular, the issue of practitioner involvement, are highlighted. These issues, relating both to counselling psychology’s engagement in practice-based research, and practitioners’ engagement in practice-research networks, suggest an exploration of the role of practitioner research training. Empirical literature relating to current counselling psychology research training programmes is reviewed. Recently, in the US and in Europe, a model of ‘practice-based research training’ has emerged as the next generation of practice-research network. Practice-based research training, as its name implies, involves the close integration of the activities of clinical practice, research and training. Examples of practice-based research training initiatives are outlined.ConclusionThis paper aims to highlight the importance and relevance of practice-based research to counselling psychology in the UK and beyond. Practice-based research training is proposed as a highly promising paradigm for counselling psychology, with potential to ameliorate the gaps, deficits and challenges reported in this review.