scholarly journals Correction to: Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Briana S. Last ◽  
Simone H. Schriger ◽  
Carter E. Timon ◽  
Hannah E. Frank ◽  
Alison M. Buttenheim ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Qualitative Study ◽  
Clinical Decision Making ◽  
Public Mental Health ◽  
Implementation Strategies ◽  
Clinical Decision ◽  
Mental Health Settings

An amendment to this paper has been published and can be accessed via the original article.

scholarly journals Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

2020 ◽  
Author(s):  
Briana S Last ◽  
Simone H Schriger ◽  
Carter E. Timon ◽  
Hannah E Frank ◽  
Alison M. Buttenheim ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Behavioral Therapy ◽  
Qualitative Interviews ◽  
Public Mental Health ◽  
Implementation Strategies ◽  
Traumatic Experience ◽  
Evidence Based ◽  
Mental Health Settings

Abstract Background: Trauma focused-cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that TF-CBT clinicians complete TNs with only half of their clients, yet little is known about what determines TF-CBT clinicians’ use of TNs. The behavioral insights literature—an interdisciplinary field studying judgment and decision-making—offers theoretical and empirical tools to conceptualize what drives complex human behaviors and decisions. Drawing from the behavioral insights literature, the present study seeks to understand what determines clinician use of TNs and to generate strategies that target these determinants. Methods: Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT clinicians working in public mental health settings across the city of Philadelphia (N =17) to understand their decisions to use TNs with clients. We analyzed the qualitative data using a coding approach informed by the behavioral insights literature. We used an iterative process of structured hypothesis generation, aided by a behavioral insights guide, and rapid validation informed by behavioral insights to uncover the determinants of TN use. We then generated implementation strategies that targeted these determinants using the “Easy Attractive Social Timely” framework, a behavioral insights design approach. Results: We generated and validated three broad themes about what determines clinician implementation of TNs: decision complexity, clinician affective experience, and agency norms. We hypothesized behavioral insights that underlie these implementation determinants and designed a list of nine corresponding behavioral insights strategies that may facilitate TN implementation. Conclusions: Our study investigated why an effective component of an evidence-based intervention is difficult to implement. We leveraged robust scientific theories and empirical regularities from the behavioral insights literature to understand clinician perspectives on TN implementation. These factors were theoretically linked to implementation strategies. Our work revealed the potential for using behavioral insights in the diagnosis of evidence-based intervention determinants and the design of implementation strategies.

scholarly journals Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

2020 ◽  
Author(s):  
Briana S Last ◽  
Simone H Schriger ◽  
Carter E. Timon ◽  
Hannah E Frank ◽  
Alison M. Buttenheim ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Behavioral Therapy ◽  
Qualitative Interviews ◽  
Public Mental Health ◽  
Implementation Strategies ◽  
Traumatic Experience ◽  
Evidence Based ◽  
Mental Health Settings

Abstract Background: Trauma focused-cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that only half of TF-CBT clinicians complete the TN with their clients. Drawing from the behavioral insights literature—an interdisciplinary field studying judgment and decision-making—the present study seeks to understand what determines clinician use of the TN and to generate strategies that target these determinants. Methods: Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT clinicians working in public mental health settings across the city of Philadelphia (n=17) to understand their decisions to use the TN with clients. We analyzed the qualitative data using a coding approach informed by the behavioral insights literature. We used an iterative process of structured hypothesis generation, aided by a behavioral insights guide, and rapid validation informed by behavioral insights to uncover the determinants of TN use. We then generated implementation strategies that targeted these determinants using the “Easy Attractive Social Timely” framework, a behavioral insights design approach. Results: We generated and validated three broad themes about what determines clinician implementation of the TN: decision complexity, clinician affective experience, and agency norms. We hypothesized the behavioral insights that underlie these implementation determinants and generated a list of nine behavioral insights strategies that theoretically may facilitate TN implementation. Conclusions: Our study investigated why an effective component of an evidence-based intervention is difficult to implement. We leveraged robust scientific theories and empirical regularities from the behavioral insights literature to understand clinician perspectives on TN implementation. These factors were theoretically linked to implementation strategies. Our work revealed the potential for using behavioral insights in the diagnosis of evidence-based intervention determinants and the design of implementation strategies.

scholarly journals Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

2020 ◽  
Author(s):  
Briana Shiri Last ◽  
Simone H Schriger ◽  
Carter E. Timon ◽  
Hannah E Frank ◽  
Alison M. Buttenheim ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Behavioral Therapy ◽  
Qualitative Interviews ◽  
Public Mental Health ◽  
Implementation Strategies ◽  
Traumatic Experience ◽  
Evidence Based ◽  
Mental Health Settings

Abstract Background: Trauma focused-cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that only half of TF-CBT clinicians complete the TN with their clients. Drawing from the behavioral insights literature—an interdisciplinary field studying judgment and decision-making—the present study seeks to understand what determines clinician use of the TN and to generate strategies that target these determinants. Methods: Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT clinicians working in public mental health settings across the city of Philadelphia (n=17) to understand their decisions to use the TN with clients. We analyzed the qualitative data using a coding approach informed by the behavioral insights literature. We used an iterative process of structured hypothesis generation, aided by a behavioral insights guide, and rapid validation informed by behavioral insights to uncover the determinants of TN use. We then generated implementation strategies that targeted these determinants using the “Easy Attractive Social Timely” framework, a behavioral insights design approach. Results: We generated and validated three broad themes about what determines clinician implementation of the TN: decision complexity, clinician affective experience, and agency norms. We hypothesized the behavioral insights that underlie these implementation determinants and generated a list of nine behavioral insights strategies that theoretically may facilitate TN implementation. Conclusions: Our study investigated why an effective component of an evidence-based intervention is often neglected. We leveraged robust scientific theories and empirical regularities from the behavioral insights literature to understand clinician perspectives on TN implementation. These factors were theoretically linked to implementation strategies. Our work revealed the potential for using behavioral insights in the diagnosis of evidence-based intervention determinants and the design of implementation strategies.

scholarly journals Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

2020 ◽  
Author(s):  
Briana Shiri Last ◽  
Simone H Schriger ◽  
Carter E. Timon ◽  
Hannah E Frank ◽  
Alison M. Buttenheim ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Implementation Strategies ◽  
Clinical Decision ◽  
Barriers And Facilitators ◽  
Trauma Narrative ◽  
Stakeholder Perspectives ◽  
Essential Components ◽  
Mental Health Settings

Abstract Background : Most studies evaluating the barriers and facilitators to evidence-based practice (EBP) implementation tend to overrely on stakeholder perspectives; underuse theory; and evaluate implementation of entire packages or protocols rather than specific, essential components of EBPs. These approaches make it challenging to generate implementation strategies that mechanistically target the core causes of behavior change. The present study seeks to leverage behavioral insights to identify factors that affect clinical decision-making surrounding the use of the trauma narrative (TN), the most active component of trauma focused-cognitive behavioral therapy (TF-CBT)—the gold standard EBP for youth with posttraumatic stress disorder—and to generate implementation strategies informed by these insights. Methods : Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT therapists working in community mental health settings across the city of Philadelphia ( n =17) surrounding their clinical decision-making around when and why they use TNs. We used an iterative process of structured brainstorming and rapid validation informed by behavioral insights to uncover the barriers and facilitators to TN use and to generate implementation strategies using the “Easy Attractive Social Timely” (EAST) framework to increase TN implementation. Results : We generated and validated 9 hypothesized barriers to and facilitators of implementation of the trauma narrative that mapped onto 18 behavioral insights. Hypothesized barriers linked therapist perspectives (i.e., the barriers and facilitators they described) and behavioral insights to design 9 implementation strategies. Conclusions : The study responds to the growing need to identify implementation barriers and facilitators and to design implementation strategies that are informed by stakeholder perspectives, causal theories and that target specific components of EBPs. Our results reveal that behavioral insights of TN implementation can generate strategy designs. In the future, we will test the implementation strategies we designed to evaluate whether this process of developing implementation strategies is effective.

scholarly journals Using Behavioral Insights to Design Implementation Strategies in Public Mental Health Settings: a Qualitative Study of Clinical Decision-Making

2020 ◽  
Author(s):  
Briana S Last ◽  
Simone H Schriger ◽  
Carter E. Timon ◽  
Hannah E Frank ◽  
Alison M. Buttenheim ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Behavioral Therapy ◽  
Qualitative Interviews ◽  
Public Mental Health ◽  
Implementation Strategies ◽  
Traumatic Experience ◽  
Evidence Based ◽  
Mental Health Settings

Abstract Background: Trauma focused-cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that only half of TF-CBT clinicians complete the TN with their clients. Drawing from the behavioral insights literature—an interdisciplinary field studying judgment and decision-making—the present study seeks to understand what determines clinician use of the TN and to generate strategies that target these determinants. Methods: Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT clinicians working in public mental health settings across the city of Philadelphia (n=17) to understand their decisions to use the TN with clients. We analyzed the qualitative data using a coding approach informed by the behavioral insights literature. We used an iterative process of structured hypothesis generation, aided by a behavioral insights guide, and rapid validation informed by behavioral insights to uncover the determinants of TN use. We then generated implementation strategies that targeted these determinants using the “Easy Attractive Social Timely” framework, a behavioral insights design approach. Results: We generated and validated three broad themes about what determines clinician implementation of the TN: decision complexity, clinician affective experience, and agency norms. We hypothesized the behavioral insights that underlie these implementation determinants and generated a list of nine behavioral insights strategies that theoretically may facilitate TN implementation. Conclusions: Our study investigated why an effective component of an evidence-based intervention is often neglected. We leveraged robust scientific theories and empirical regularities from the behavioral insights literature to understand clinician perspectives on TN implementation. These factors were theoretically linked to implementation strategies. Our work revealed the potential for using behavioral insights in the diagnosis of evidence-based intervention determinants and the design of implementation strategies.

scholarly journals Probability and loss: two sides of the risk assessment coin

2011 ◽  
Vol 35 (11) ◽  
pp. 413-418 ◽  
Author(s):  
Matthew M. Large ◽  
Olav B. Nielssen
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Other ◽  
Current Form ◽  
Mental Health Settings ◽  
Future Harm ◽  
Two Sides

SummaryRisk assessment has been widely adopted in mental health settings in the hope of preventing harms such as violence to others and suicide. However, risk assessment in its current form is mainly concerned with the probability of adverse events, and does not address the other component of risk – the extent of the resulting loss. Although assessments of the probability of future harm based on actuarial instruments are generally more accurate than the categorisations made by clinicians, actuarial instruments are of little assistance in clinical decision-making because there is no instrument that can estimate the probability of all the harms associated with mental illness, or estimate the extent of the resulting losses. The inability of instruments to distinguish between the risk of common but less serious harms and comparatively rare catastrophic events is a particular limitation of the value of risk categorisations. We should admit that our ability to assess risk is severely limited, and make clinical decisions in a similar way to those in other areas of medicine – by informed consideration of the potential consequences of treatment and non-treatment.

scholarly journals Paramedic experiences of providing care in wales (UK) during the 2020 COVID-19 pandemic (PECC-19): a qualitative study using evolved grounded theory

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e048677
Author(s):  
Nigel Rees ◽  
Lauren Smythe ◽  
Chloe Hogan ◽  
Julia Williams
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Grounded Theory ◽  
Qualitative Study ◽  
Health Services ◽  
Clinical Decision Making ◽  
Social Process ◽  
Well Being ◽  
Clinical Decision ◽  
The Impact

ObjectiveTo explore paramedic experiences of providing care during the 2020 COVID-19 pandemic and develop theory in order to inform future policy and practice.DesignQualitative study using constructivist evolved grounded theory (EGT) methodology. One-to-one semistructured interviews were conducted using a general interview guide. Voice over Internet Protocol was used through Skype.SettingConducted between March 2020 and November 2020 in the Welsh Ambulance Services National Health Services Trust UK which serves a population of three million.ParticipantsParamedics were recruited through a poster circulated by email and social media. Following purposive sampling, 20 Paramedics were enrolled and interviewed.ResultsEmergent categories included: Protect me to protect you, Rapid disruption and adaptation, Trust in communication and information and United in hardship. The Basic Social Process was recognised to involve Tragic Choices, conceptualised through an EGT including Tragic personal and professional choices including concerns over personnel protective equipment (PPE), protecting themselves and their families, impact on mental health and difficult clinical decisions, Tragic organisational choices including decision making support, communication, mental health and well-being and Tragic societal choices involving public shows of support, utilisation and resourcing of health services.ConclusionsRich insights were revealed into paramedic care during the COVID-19 pandemic consistent with other research. This care was provided in the context of competing and conflicting decisions and resources, where Tragic Choices have to be made which may challenge life’s pricelessness. Well-being support, clinical decision making, appropriate PPE and healthcare resourcing are all influenced by choices made before and during the pandemic, and will continue as we recover and plan for future pandemics. The impact of COVID-19 may persist, especially if we fail to learn, if not we risk losing more lives in this and future pandemics and threatening the overwhelming collective effort which united society in hardship when responding to the COVID-19 Pandemic.Trial registration numberIRAS ID: 282 623.

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