scholarly journals How Low Can You Go? Examining the Effects of Brief Online Training and Post-Training Consultation Dose on Implementation Mechanisms and Outcomes for Measurement-Based Care

2021 ◽  
Author(s):  
Aaron R Lyon ◽  
Freda F. Liu ◽  
Elizabeth H. Connors ◽  
Kevin M. King ◽  
Jessica I. Coifman ◽  
...  
Keyword(s):  
Mental Health ◽  
Multilevel Models ◽  
Implementation Strategies ◽  
Online Training ◽  
Standardized Assessment ◽  
Clinical Trial Registration ◽  
Treatment Modification ◽  
Linear Effect ◽  
Measurement Based Care ◽  
Over Time

Abstract Background: Initial training and ongoing post-training consultation are among the most common implementation strategies used to change clinician practice. However, extant research has not experimentally investigated the optimal dosages of consultation necessary to produce desired outcomes. Moreover, the degree to which training and consultation engage theoretical implementation mechanisms – such as provider knowledge, skills, and attitudes – is not well understood. This study examined the effects of a brief online training and varying dosages of post-training consultation (BOLT+PTC) on implementation mechanisms and outcomes for measurement-based care (MBC) practices delivered in education sector mental health services. Methods: A national sample of 75 clinicians who provide mental health interventions to children and adolescents in schools were randomly assigned to BOLT+PTC or control (services as usual). Those in BOLT+PTC were further randomized to 2-, 4-, or 8- week consultation conditions. Self-reported MBC knowledge, skills, attitudes, and use (including standardized assessment, individualized assessment, and assessment-informed treatment modification) were collected for 32 weeks. Multilevel models were used to examine main effects of BOLT+PTC versus control on MBC use at the end of consultation and over time, as well as comparisons among PTC dosage conditions and theorized mechanisms (skills, attitudes, knowledge). Results: There was a significant linear effect of BOLT+PTC over time on standardized assessment use (b = .02, p < .01), and a significant quadratic effect of BOLT+PTC over time on individualized assessment use (b = .04, p < .001), but no significant effect on treatment modification. BOLT + any level of PTC resulted in higher MBC knowledge and larger growth in MBC skill over the intervention period as compared to control. PTC dosage levels were inconsistently predictive of outcomes, providing no clear evidence for added benefit of higher PTC dosage. Conclusions: Online training and consultation in MBC had effects on standardized and individualized assessment use among clinicians as compared to services as usual with no consistent benefit detected for increased consultation dosage. Continued research investigating optimal dosages and mechanisms of these established implementation strategies is needed to ensure training and consultation resources are deployed efficiently to impact clinician practices.Clinical Trial Registration: Not applicable.

Presence of a Secondary Caregiver Differentiates Primary Cancer Caregiver Well-being

2021 ◽  
Author(s):  
Maria Thomson ◽  
Maureen Wilson-Genderson ◽  
Laura A Siminoff
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Multilevel Models ◽  
Case Series ◽  
Primary Caregivers ◽  
Well Being ◽  
Physical And Mental Health ◽  
Hematological Cancer ◽  
Cancer Caregiver ◽  
Over Time

Abstract Background Informal caregivers play a fundamental role in the care of hematological cancer patients, but less is known about how secondary caregivers are involved. We assessed the presence or absence of a secondary caregiver, the types of caregiving activities performed by primary and secondary caregivers and examined whether the presence of a secondary caregiver was associated with primary caregiver characteristics and wellbeing over time. Methods A case series of hematological cancer patient-caregiver dyads (n = 171) were recruited from oncology clinics in Virginia and Pennsylvania and followed for 2 years. Multi-level models were developed to examine the associations between presence of a secondary caregiver and the primary caregivers’ well-being. Results Most (64.9%) primary caregivers reported having secondary caregivers. Multilevel models showed primary caregivers without help had higher baseline mental and physical health, but experienced deteriorating physical health overtime, compared to supported primary caregivers. Supported primary caregivers reported improvements in mental health over time that was associated with improvements in physical health. Conclusions Primary caregivers in good physical and mental health at the beginning of their caregiving journey but who have the least assistance from others may be at greatest risk for detrimental physical health effects long term. Attention to the arrangement of caregiving roles (i.e., who provides what care) overtime is needed to ensure that caregivers remain healthy and well supported.

scholarly journals The Results of Clinician-Focused Implementation Strategies on Uptake and Outcome of Measurement-Based Care in General Mental Health Care

2021 ◽  
Author(s):  
Maartje van Sonsbeek ◽  
Giel J. M. Hutschemaekers ◽  
Jan W. Veerman ◽  
Ad Vermulst ◽  
Bea G. Tiemens
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Treatment Outcome ◽  
Mental Health Care ◽  
Implementation Strategies ◽  
Completion Rate ◽  
Treatment Length ◽  
General Mental Health ◽  
Measurement Based Care ◽  
Satisfaction With Treatment

Abstract BACKGROUND: Measurement-Based Care (MBC) is a promising way to improve outcomes in clinical practice, but the implementation of MBC is often problematic and the uptake by clinicians is low.METHODS: We used an effectiveness-implementation hybrid design based on Grol and Wensing’s implementation framework to examine the results of clinician-focused implementation strategies on both clinicians’ uptake of MBC and outcomes of MBC for clients in general mental health care. Primary outcomes were questionnaire completion rate and discussion of feedback. Secondary outcomes were treatment outcome, treatment length, and satisfaction with treatment. RESULTS: There was a significant medium effect of the MBC implementation strategies on questionnaire completion rate (one part of the clinicians’ uptake), but no significant effect on the amount of discussion of the feedback (the other part of the clinicians’ uptake). Neither was there a significant effect on clients’ outcomes (treatment outcome, treatment length, satisfaction with treatment).CONCLUSIONS: Establishing and sustaining MBC in real world general mental health care is very complex. Our study helps to disentangle the effects of MBC implementation strategies on differential clinician uptake, but the effects of MBC implementation strategies on client outcomes need further examination.

scholarly journals Implementation Strategies to Promote Measurement-Based Care in Schools: Evidence from Mental Health Experts Across the United States

2021 ◽  
Author(s):  
Elizabeth H Connors ◽  
Aaron R Lyon ◽  
Kaylyn Garcia ◽  
Corianna Sichel ◽  
Sharon Hoover ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
Implementation Strategies ◽  
Health Service Delivery ◽  
The United States ◽  
Mental Health Providers ◽  
Health Providers ◽  
Mental Health Service Delivery ◽  
Measurement Based Care ◽  
Patient Reported

Abstract Background: Despite an established, comprehensive taxonomy of implementation strategies, minimal guidance exists for how to select and adapt strategies to specific services and contexts. We employed a replicable method to identify the most feasible and important implementation strategies to increase mental health providers’ use of measurement-based care (MBC) in schools. MBC is the routine use of patient-reported progress measures throughout treatment to inform patient-centered, data-driven treatment adjustments. Methods: A national sample of 52 school mental health providers and researchers completed two rounds of modified Delphi surveys to rate the relevance, importance, and feasibility of 33 implementation strategies identified for school settings. Strategies were reduced and definitions refined using a multimethod approach. Final importance and feasibility ratings were plotted on “go-zone” graphs and compared across providers and researchers to identify top-rated strategies. Results: The initial 33 strategies were rated as “relevant” or “relevant with changes” to MBC in schools. Importance and feasibility ratings were high overall for both survey rounds; importance ratings (3.61 - 4.48) were higher than feasibility ratings (2.55 – 4.06) on average. Survey 1 responses resulted in a reduced, refined set of 21 strategies, and six were rated most important and feasible on Survey 2: 1) assess for readiness and identify barriers and facilitators; 2) identify and prepare champions; 3) develop a usable implementation plan; 4) offer a provider-informed menu of free, brief measures; 5) develop and provide access to training materials; and 6) make implementation easier by removing burdensome documentation tasks. Provider and researcher ratings were not significantly different, with a few exceptions: providers reported higher feasibility and importance of removing burdensome paperwork than researchers, and providers reported higher feasibility of train-the trainer approaches than researchers; researchers reported higher importance of monitoring fidelity than providers. Conclusions: The education sector is the most common setting for child and adolescent mental health service delivery in the United States. Effective MBC implementation in schools has the potential to elevate the quality of care received by many children, adolescents and their families. This empirically-derived, targeted list of six implementation strategies offers potential efficiencies for future testing of MBC implementation in schools.

scholarly journals Associations Between Global Mental Health and Response to an App-Based Meditation Intervention in Myeloproliferative Neoplasm Patients

2020 ◽  
Vol 19 ◽  
pp. 153473542092778
Author(s):  
Megan E. Puzia ◽  
Jennifer Huberty ◽  
Ryan Eckert ◽  
Linda Larkey ◽  
Ruben Mesa
Keyword(s):  
Mental Health ◽  
Sleep Disturbance ◽  
Mindfulness Meditation ◽  
Multilevel Models ◽  
Global Mental Health ◽  
Myeloproliferative Neoplasm ◽  
Anxiety Symptoms ◽  
Control Group ◽  
Depression And Anxiety ◽  
Over Time

Background: Depression, anxiety, and sleep disturbance are common problems that greatly affect quality of life for many myeloproliferative neoplasm (MPN) patients. App-based mindfulness meditation is a feasible nonpharmacologic approach for managing symptoms. However, previous research has not considered how patients’ overall mental health may influence their responsiveness to these interventions. Objective: The purpose of this study was to conduct an exploratory, secondary analysis of the effects of a smartphone meditation app, Calm, on depression, anxiety, and sleep disturbance in MPN patients based on patients’ baseline levels of Global Mental Health (GMH). Methods: Participants (N = 80) were a subset of MPN patients from a larger feasibility study. Patients were enrolled into an intervention (use Calm for 10 minutes daily for 4 weeks) or educational control group. Results: In multilevel models, there were significant 3-way interactions between time, group, and baseline GMH for depression and anxiety symptoms, with participants in the meditation intervention who reported the poorest baseline GMH experiencing the greatest reduction in symptoms over time. For both intervention and control participants, poorer initial GMH was associated with increases in sleep disturbance symptoms over time. Conclusions: Mindfulness meditation apps, such as Calm, may be effective in reducing depression and anxiety symptoms in MPN patients, particularly for those experiencing mental health difficulties. Given the need for accessible tools to self-manage chronic cancer–related symptoms, especially strong negative emotions, these findings warrant larger efficacy studies to determine the effects of app-based meditation for alleviating depression and anxiety in cancer populations.

scholarly journals Global Sensory Impairment Independently Predicts Decreased Social Function Over Time

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 414-414
Author(s):  
Anna Huang ◽  
Kristen Wroblewski ◽  
Ashwin Kotwal ◽  
Linda Waite ◽  
Martha McClintock ◽  
...  
Keyword(s):  
Mental Health ◽  
Logistic Regression ◽  
Cognitive Function ◽  
Social Engagement ◽  
Social Function ◽  
Ordinal Logistic Regression ◽  
Sensory Function ◽  
Sensory Impairment ◽  
Over Time

Abstract The classical senses (vision, hearing, touch, taste, and smell) play a key role in social function by allowing interaction and communication. We assessed whether sensory impairment across all 5 modalities (global sensory impairment [GSI]) was associated with social function in older adults. Sensory function was measured in 3,005 home-dwelling older U.S. adults at baseline in the National Social Life, Health, and Aging Project and GSI, a validated measure, was calculated. Social network size and kin composition, number of close friends, and social engagement were assessed at baseline and 5- and 10-year follow-up. Ordinal logistic regression and mixed effects ordinal logistic regression analyzed cross-sectional and longitudinal relationships respectively, controlling for demographics, physical/mental health, disability, and cognitive function (at baseline). Adults with worse GSI had smaller networks (β=-0.159, p=0.021), fewer close friends (β=-0.262, p=0.003) and lower engagement (β=-0.252, p=0.006) at baseline, relationships that persisted at 5 and 10 year follow-up. Men, older people, African-Americans, and those with less education, fewer assets, poor mental health, worse cognitive function, and more disability had worse GSI. Men and those with fewer assets, worse cognitive function, and less education had smaller networks and lower engagement. African-American and Hispanic individuals had smaller networks and fewer close friends, but more engagement. Older respondents also had more engagement. In summary, GSI independently predicts smaller social networks, fewer close friends, and lower social engagement over time, suggesting that sensory decline results in decreased social function. Thus, rehabilitating multisensory impairment may be a strategy to enhance social function as people age.

scholarly journals Fluctuations in barriers to medication treatment for opioid use disorder prescribing over the course of a one-year external facilitation intervention

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Allison M. Gustavson ◽  
Marie E. Kenny ◽  
Jennifer P. Wisdom ◽  
Hope A. Salameh ◽  
Princess E. Ackland ◽  
...  
Keyword(s):  
Implementation Strategies ◽  
Opioid Use Disorder ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Use ◽  
Medication Treatment ◽  
Conceptual Clarity ◽  
Parihs Framework ◽  
External Facilitation ◽  
Over Time

Abstract Background The Veterans Health Administration (VHA) is invested in expanding access to medication treatment for opioid use disorder (MOUD) to save lives. Access varies across VHA facilities and, thus, requires implementation strategies to promote system-wide adoption of MOUD. We conducted a 12-month study employing external facilitation that targeted MOUD treatment among low-adopting VHA facilities. In this study, we sought to evaluate the patterns of perceived barriers over 1 year of external implementation facilitation using the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Methods We randomly selected eight VHA facilities from the bottom quartile of the proportion of Veterans with an OUD diagnosis receiving MOUD (< 21%). The 1-year external implementation intervention included developmental evaluation to tailor the facilitation, an on-site visit, and monthly facilitation calls. Facilitators recorded detailed notes for each call on a structured template. Qualitative data was analyzed by coding and mapping barriers to the constructs in the i-PARIHS framework (Innovation, Recipients, Context). We identified emerging themes within each construct by month. Results Barriers related to the Innovation, such as provider perception of the need for MOUD in their setting, were minimal throughout the 12-month study. Barriers related to Recipients were predominant and fluctuated over time. Recipient barriers were common during the initial months when providers did not have the training and waivers necessary to prescribe MOUD. Once additional providers (Recipients) were trained and waivered to prescribe MOUD, Recipient barriers dropped and then resurfaced as the facilities worked to expand MOUD prescribing to other clinics. Context barriers, such as restrictions on which clinics could prescribe MOUD and fragmented communication across clinics regarding the management of patients receiving MOUD, emerged more prominently in the middle of the study. Conclusions VHA facilities participating in 12-month external facilitation interventions experienced fluctuations in barriers to MOUD prescribing with contextual barriers emerging after a facilitated reduction in recipient- level barriers. Adoption of MOUD prescribing in low-adopting VHA facilities requires continual reassessment, monitoring, and readjustment of implementation strategies over time to meet challenges. Although i-PARIHS was useful in categorizing most barriers, the lack of conceptual clarity was a concern for some constructs.

scholarly journals Change in medical practice over time? A register based study of regional trends in hysterectomy in Finland in 2001–2018

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tiina Vikstedt ◽  
Martti Arffman ◽  
Satu Heliövaara-Peippo ◽  
Kristiina Manderbacka ◽  
Eeva Reissell ◽  
...  
Keyword(s):  
Multilevel Models ◽  
Medical Decision ◽  
Hospital Discharges ◽  
Female Population ◽  
Medical Practices ◽  
Hospital District ◽  
Regional Trends ◽  
Region Of Residence ◽  
Total Female ◽  
Over Time

Abstract Background A persistent research finding in Finland and elsewhere has been variation in medical practices both between and within countries. Variation seems to exist especially if medical decision making involves discretion and the best treatment cannot be identified unambiguously. This is true for hysterectomy when performed for benign causes. The aim of the current study was to investigate regional trends in hysterectomy in Finland and the potential convergence of rates over time. Methods We used hospital discharge register data on hysterectomies performed, diagnoses, age, and region of residence to examine hospital discharges for women undergoing hysterectomy in 2001–2018 among total female population aged 25 years or older in Finland. We examined hysterectomy rates among biannual cohorts by indication, calculated age-standardised rates and used multilevel models to analyse potential convergence over time. Results Altogether 131,695 hysterectomies were performed in Finland 2001–2018. We found a decreasing trend, with the age-adjusted overall hysterectomy rate decreasing from 553/100,000 person years in 2001–2002 to 289/100,000 py in 2017–2018. Large but converging regional differences were found. The correlations between hospital district intercepts and slopes in time ranged from − 0.71 to − 0.97 (p < 0.001) suggesting diminishing variation. Conclusions Our findings demonstrate that change in hysterectomy practices and more uniformity across regions are achievable goals. Regional variation still exists suggesting differences in medical practices.

scholarly journals Levels of physical activity in four domains and affective wellbeing before and during the Covid-19 pandemic

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Eliane S. Engels ◽  
Michael Mutz ◽  
Yolanda Demetriou ◽  
Anne K. Reimers
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Protective Factor ◽  
Total Sample ◽  
Poor Mental Health ◽  
German Population ◽  
Time Points ◽  
Sport And Exercise ◽  
Over Time ◽  
Time Point

Abstract Background Latest studies indicated that the general mental health level is low during the pandemic. Probably, this deterioration of the mental health situation is partly due to declines in physical activity. The aim of this study was to investigate differences in and the association between affective wellbeing and levels of different domains of physical activity at three time points before and during the pandemic. Method We used a nationwide online panel with a trend data design encompassing a total sample of N = 3517, representing the German population (> 14 years). Four different activity domains (sport and exercise, light outdoor activity, housework/gardening, active travel) and affective wellbeing (positive and negative affect) were assessed at three time points before and during the Covid-19 pandemic (October 2019, March 2020, October 2020). Results Multivariate analyses of variance (MANOVA) indicate differences regarding affective wellbeing over the three time points with the lowest values at the second time point. Levels of activity in the four domains differed significantly over time with the strongest decrease for sport and exercise from the first to the second time point. Partial correlations indicated that the relationships between sport and exercise and positive affect were most consistent over time. Conclusions Overall, our findings suggest that physical activity plays a particularly important role in the pandemic period as a protective factor against poor mental health. Especially sports and exercise seem to be supportive and should be encouraged, e.g. by providing additional support in finding adequate outdoor, home-based or digital substitutes.

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