The Experts below are selected from a list of 933243 Experts worldwide ranked by ideXlab platform
Rinad S Beidas - One of the best experts on this subject based on the ideXlab platform.
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characterizing the heterogeneity of Clinician practice use in community mental health using latent profile analysis
BMC Psychiatry, 2019Co-Authors: Rinad S Beidas, Emily M Beckerhaimes, Viktor Lushin, Torrey A CreedAbstract:The behavioral health service provider population is highly heterogeneous. However, it is rarely treated as such within evidence-based practice implementation efforts. This study aimed to evaluate, as a proof of concept, the utility of latent profile analysis to identify distinct profiles of Clinician practices in a large sample of youth-serving community mental health Clinicians. This study also aimed to identify predictors of profile membership to inform implementation efforts. Participants were 484 practicing Clinicians (79.4% female, 45.7% White, M age = 37.1 years). As part of a larger survey, Clinicians reported on their use of cognitive, behavioral, family, and psychodynamic treatment techniques with a representative client on their caseload. Latent profile analysis was used to determine the presence of Clinician practice profiles. Multilevel multinomial logistic regressions examined predictors of profile membership. Latent profile analysis indicated a 4-profile solution best fit the data, with Clinicians who: 1) used generally low levels of all examined techniques and preferred cognitive techniques (Low Eclectics, 16%), 2) delivered moderate levels of all techniques (Moderate Eclectics, 53%), 3) demonstrated preference for use of family techniques (Family Preferred, 11%), and 4) used high levels of all techniques (Super Users, 20%). Clinician discipline (e.g., social work), education, and years of experience predicted profile membership. Findings from this proof of concept study underscore the utility of latent profile analysis to characterize the complex and heterogeneous makeup of community mental health. Results extend prior work highlighting the eclectic nature of community mental health practice. Predictor analyses underscore the important influence of Clinician background characteristics on practice use.
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the relationship between consumer Clinician and organizational characteristics and use of evidence based and non evidence based therapy strategies in a public mental health system
Behaviour Research and Therapy, 2017Co-Authors: Rinad S Beidas, Laura C Skriner, Danielle R Adams, Courtney Benjamin Wolk, Rebecca E Stewart, Emily M Beckerhaimes, Nathaniel J Williams, Brenna B MaddoxAbstract:Abstract We investigated the relationship between consumer, Clinician, and organizational factors and Clinician use of therapy strategies within a system-wide effort to increase the use of cognitive-behavioral therapy. Data from 247 Clinicians in 28 child-serving organizations were collected. Clinicians participating in evidence-based practice training initiatives were more likely to report using cognitive-behavioral therapy when they endorsed more clinical experience, being salaried Clinicians, and more openness to evidence-based practice. Clinicians participating in evidence-based practice initiatives were more likely to use psychodynamic techniques when they had older clients, less knowledge about evidence-based practice, more divergent attitudes toward EBP, higher financial strain, and worked in larger organizations. In Clinicians not participating in evidence-based training initiatives; depersonalization was associated with higher use of cognitive-behavioral; whereas Clinicians with less knowledge of evidence-based practices were more likely to use psychodynamic techniques. This study suggests that Clinician characteristics are important when implementing evidence-based practices; and that consumer, Clinician, and organizational characteristics are important when de-implementing non evidence-based practices. This work posits potential characteristics at multiple levels to target with implementation and deimplementation strategies.
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predictors of Clinician use of exposure therapy in community mental health settings
Journal of Anxiety Disorders, 2017Co-Authors: Emily M Beckerhaimes, Courtney Benjamin Wolk, Kelsie H Okamura, Ronnie Rubin, Arthur C Evans, Rinad S BeidasAbstract:Exposure therapy is recognized as the key component of cognitive-behavioral treatment for anxiety. However, exposure is the least used evidence-based treatment in community mental health settings and is the most challenging technique for Clinicians to adopt within the context of effectiveness and implementation trials. Little work has examined Clinician and organizational characteristics that predict use of exposure, which is important for identifying implementation strategies that may increase its use. In a large sample of community health Clinicians (N = 335) across 31 clinical practice sites, this study characterized Clinician and organizational predictors of exposure use and relaxation for anxiety. Mixed effects regression analyses indicated that both Clinician attitudes and an organization’s implementation climate may be important levers for interventions seeking to increase Clinician exposure use. Greater Clinician use of relaxation strategies was also associated with less exposure use. Results point to important implications for implementing cognitive-behavioral therapy for anxiety, including de-emphasizing relaxation and attending to organizational climate.
Emily M Beckerhaimes - One of the best experts on this subject based on the ideXlab platform.
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characterizing the heterogeneity of Clinician practice use in community mental health using latent profile analysis
BMC Psychiatry, 2019Co-Authors: Rinad S Beidas, Emily M Beckerhaimes, Viktor Lushin, Torrey A CreedAbstract:The behavioral health service provider population is highly heterogeneous. However, it is rarely treated as such within evidence-based practice implementation efforts. This study aimed to evaluate, as a proof of concept, the utility of latent profile analysis to identify distinct profiles of Clinician practices in a large sample of youth-serving community mental health Clinicians. This study also aimed to identify predictors of profile membership to inform implementation efforts. Participants were 484 practicing Clinicians (79.4% female, 45.7% White, M age = 37.1 years). As part of a larger survey, Clinicians reported on their use of cognitive, behavioral, family, and psychodynamic treatment techniques with a representative client on their caseload. Latent profile analysis was used to determine the presence of Clinician practice profiles. Multilevel multinomial logistic regressions examined predictors of profile membership. Latent profile analysis indicated a 4-profile solution best fit the data, with Clinicians who: 1) used generally low levels of all examined techniques and preferred cognitive techniques (Low Eclectics, 16%), 2) delivered moderate levels of all techniques (Moderate Eclectics, 53%), 3) demonstrated preference for use of family techniques (Family Preferred, 11%), and 4) used high levels of all techniques (Super Users, 20%). Clinician discipline (e.g., social work), education, and years of experience predicted profile membership. Findings from this proof of concept study underscore the utility of latent profile analysis to characterize the complex and heterogeneous makeup of community mental health. Results extend prior work highlighting the eclectic nature of community mental health practice. Predictor analyses underscore the important influence of Clinician background characteristics on practice use.
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the relationship between consumer Clinician and organizational characteristics and use of evidence based and non evidence based therapy strategies in a public mental health system
Behaviour Research and Therapy, 2017Co-Authors: Rinad S Beidas, Laura C Skriner, Danielle R Adams, Courtney Benjamin Wolk, Rebecca E Stewart, Emily M Beckerhaimes, Nathaniel J Williams, Brenna B MaddoxAbstract:Abstract We investigated the relationship between consumer, Clinician, and organizational factors and Clinician use of therapy strategies within a system-wide effort to increase the use of cognitive-behavioral therapy. Data from 247 Clinicians in 28 child-serving organizations were collected. Clinicians participating in evidence-based practice training initiatives were more likely to report using cognitive-behavioral therapy when they endorsed more clinical experience, being salaried Clinicians, and more openness to evidence-based practice. Clinicians participating in evidence-based practice initiatives were more likely to use psychodynamic techniques when they had older clients, less knowledge about evidence-based practice, more divergent attitudes toward EBP, higher financial strain, and worked in larger organizations. In Clinicians not participating in evidence-based training initiatives; depersonalization was associated with higher use of cognitive-behavioral; whereas Clinicians with less knowledge of evidence-based practices were more likely to use psychodynamic techniques. This study suggests that Clinician characteristics are important when implementing evidence-based practices; and that consumer, Clinician, and organizational characteristics are important when de-implementing non evidence-based practices. This work posits potential characteristics at multiple levels to target with implementation and deimplementation strategies.
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predictors of Clinician use of exposure therapy in community mental health settings
Journal of Anxiety Disorders, 2017Co-Authors: Emily M Beckerhaimes, Courtney Benjamin Wolk, Kelsie H Okamura, Ronnie Rubin, Arthur C Evans, Rinad S BeidasAbstract:Exposure therapy is recognized as the key component of cognitive-behavioral treatment for anxiety. However, exposure is the least used evidence-based treatment in community mental health settings and is the most challenging technique for Clinicians to adopt within the context of effectiveness and implementation trials. Little work has examined Clinician and organizational characteristics that predict use of exposure, which is important for identifying implementation strategies that may increase its use. In a large sample of community health Clinicians (N = 335) across 31 clinical practice sites, this study characterized Clinician and organizational predictors of exposure use and relaxation for anxiety. Mixed effects regression analyses indicated that both Clinician attitudes and an organization’s implementation climate may be important levers for interventions seeking to increase Clinician exposure use. Greater Clinician use of relaxation strategies was also associated with less exposure use. Results point to important implications for implementing cognitive-behavioral therapy for anxiety, including de-emphasizing relaxation and attending to organizational climate.
Ethan Basch - One of the best experts on this subject based on the ideXlab platform.
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patient reported outcomes harnessing patients voices to improve clinical care
The New England Journal of Medicine, 2017Co-Authors: Ethan BaschAbstract:Recording patient-reported outcomes electronically in real time and allowing Clinicians to review longitudinal PRO reports can improve patients' quality of life, enhance patient–Clinician communication, reduce emergency department utilization, and lengthen survival.
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patient versus Clinician symptom reporting using the national cancer institute common terminology criteria for adverse events results of a questionnaire based study
Lancet Oncology, 2006Co-Authors: Ethan Basch, Alexia Iasonos, Tiffani L Mcdonough, Allison Barz, A Culkin, Mark G Kris, Howard I Scher, Deborah SchragAbstract:Summary Background The Common Terminology Criteria for Adverse Events (CTCAE) are used as standard practice in trials of cancer treatments by Clinicians to elicit and report toxic effects. Alternatively, patients could report this information directly as patient-reported outcomes, but the accuracy of these reports compared with Clinician reports remains unclear. We aimed to compare the reporting of symptom severity reported by patients and Clinicians. Methods Between March and May, 2005, a questionnaire with 11 common CTCAE symptoms was given to consecutive outpatients and their Clinicians (physicians and nurses) in lung and genitourinary cancer clinics in the Memorial Sloan-Kettering Cancer Center, New York, NY, USA. Patients completed a version that used language adapted from the CTCAE for patient self-reporting. The results from the questionnaire were compared with Clinician reporting of the same symptoms. Findings Of 435 patients and their Clinicians asked to take part in the study, 400 paired surveys were completed. For most symptoms, agreement between patient and Clinician was high, and most discrepancies were within a grade difference of one point. Agreement was higher for symptoms that could be observable directly, such as vomiting and diarrhoea, than for more subjective symptoms, such as fatigue and dyspnoea. Differences in symptom reporting rarely would have changed treatment decisions or dosing, and patients assigned greater severity to symptoms more than did Clinicians. No significant differences were recorded between the results when the questionnaire was completed by the patient before or after the Clinician. Interpretation Patient reporting of symptoms could add to the current approach to symptom monitoring in cancer treatment trials. Future research should assess the effect of self reporting on clinical outcomes and efficiency, and the use of real-time collection of patient-reported outcomes for early detection of potentially serious adverse events.
Rosemarie Mccabe - One of the best experts on this subject based on the ideXlab platform.
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the therapeutic relationship and adherence to antipsychotic medication in schizophrenia
PLOS ONE, 2012Co-Authors: Rosemarie Mccabe, Jens Bullenkamp, Rafael Martinezleal, Hans Joachim Salize, Lars Hansson, Christoph Lauber, Wulf Rossler, Bengt Svensson, Francisco Torresgonzalez, Rob H S Van Den BrinkAbstract:Objective: Previous research has shown that a better therapeutic relationship (TR) predicts more positive attitudes towards antipsychotic medication, but did not address whether it is also linked with actual adherence. This study investigated whether the TR is associated with adherence to antipsychotics in patients with schizophrenia. Methods: 134 Clinicians and 507 of their patients with schizophrenia or a related psychotic disorder participated in a European multi-centre study. A logistic regression model examined how the TR as rated by patients and by Clinicians is associated with medication adherence, adjusting for Clinician clustering and symptom severity. Results: Patient and Clinician ratings of the TR were weakly inter-correlated (r(s) = 0.13, p = 0.004), but each was independently linked with better adherence. After adjusting for patient rated TR and symptom severity, each unit increase in Clinician rated TR was associated with an increase of the odds ratio of good compliance by 65.9% (95% CI: 34.6% to 104.5%). After adjusting for Clinician rated TR and symptom severity, for each unit increase in patient rated TR the odds ratio of good compliance was increased by 20.8% (95% CI: 4.4% to 39.8%). Conclusions: A better TR is associated with better adherence to medication among patients with schizophrenia. Patients' and Clinicians' perspectives of the TR are both important, but may reflect distinct aspects.
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individual unmet needs for care are they sensitive as outcome criterion for the effectiveness of mental health services interventions
Social Psychiatry and Psychiatric Epidemiology, 2009Co-Authors: Durk Wiersma, Rob H S Van Den Brink, Kerstin Wolters, Rosemarie Mccabe, Jens Bullenkamp, Rafael Martinezleal, Lars Hansson, Christoph Lauber, Wulf Rossler, Hans Joachim SalizeAbstract:Background Mental health interventions should demonstrate an effect on patients' functioning as well as his/her needs, in particular on unmet needs whose assessment depends on the perspective of either the patient or the Clinician. However, individual met and unmet needs appear to change over time, qualitatively and quantitatively, raising questions about their sensitivity to change and about the association between level of needs and treatment. Methods Data on baseline and follow-up need assessment in community mental health services in four European countries in the context of a cluster randomised trial on a novel mental health service intervention were used, which involved 102 Clinicians with key worker roles and 320 patients with schizophrenia or related psychotic disorders. Need assessment was performed with the Camberwell assessment of needs short appraisal schedule (CANSAS) among patients as well as Clinicians. Focus is the sensitivity to change in unmet needs over time as well as the concordance between patient and Clinician ratings and their relationship with treatment condition. Results At follow-up 294 patients (92%) had a full need assessment, while Clinician rated needs were available for 302 patients (94%). Generally, the total number of met needs remained quite stable, but unmet needs decreased significantly over time, according to patients as well as to Clinicians. Sensitivity to change of unmet needs is quite high: about two third of all unmet needs made a transition to no or met need, and more than half of all unmet needs at follow-up were new. Agreement between patient and Clinician on unmet needs at baseline as well as follow-up was rather low, without any indication of a specific treatment effect. Conclusions Individual unmet needs appear to be quite sensitive to change over time but as yet less suitable as outcome criterion of treatment or specific interventions.
Steven K. Dobscha - One of the best experts on this subject based on the ideXlab platform.
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a qualitative analysis of how online access to mental health notes is changing Clinician perceptions of power and the therapeutic relationship
Journal of Medical Internet Research, 2017Co-Authors: Lauren M Denneson, Risa Cromer, Holly B Williams, Maura Pisciotta, Steven K. DobschaAbstract:Background: As part of the national OpenNotes initiative, the Veterans Health Administration (VHA) provides veterans online access to their clinical progress notes, raising concern in mental health settings. Objective: The aim of this study was to examine the perspectives and experiences of mental health Clinicians with OpenNotes to better understand how OpenNotes may be affecting mental health care. Methods: We conducted individual semi-structured interviews with 28 VHA mental health Clinicians and nurses. Transcripts were analyzed using a thematic analysis approach, which allows for both inductive and deductive themes to be explored using an iterative, constant comparative coding process. Results: OpenNotes is changing VHA mental health care in ways that mental health Clinicians perceive as both challenging and beneficial. At the heart of these changes is a shifting power distribution within the patient-Clinician relationship. Some Clinicians view OpenNotes as an opportunity to better partner with patients, whereas others feel that it has the potential to undo the therapeutic relationship. Many Clinicians are uncomfortable with OpenNotes, but acknowledge that this discomfort could both improve and diminish care and documentation practices. Specifically, we found that (1) OpenNotes is empowering patients, (2) OpenNotes is affecting how Clinicians build and maintain the therapeutic relationship, and (3) mental health Clinicians are adjusting their practices to protect patients and themselves from adverse consequences of OpenNotes. Conclusions: Our findings suggest that future research should monitor whether OpenNotes notes facilitates stronger patient-Clinician relationships, enhancing patient-centered mental health care, or diminishes the quality of mental health care through disruptions in the therapeutic relationship and reduced documentation. [J Med Internet Res 2017;19(6):e208]
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Qualitative analysis of US Department of veterans affairs mental health Clinician perspectives on patient-centered care
International Journal for Quality in Health Care, 2016Co-Authors: Steven K. Dobscha, Risa Cromer, Aysha Crain, Lauren M DennesonAbstract:Objective Enhanced patient involvement in care has the potential to improve patient experiences and health outcomes. As such, large national and global healthcare systems and organizations, including the US Department of Veterans Affairs (VA), have made patient-centered care a primary goal. Little is known about mental health Clinician perspectives on, and experiences with, providing patient-centered care. Our main objective was to better understand VA mental health Clinicians' perceptions of patient-centered care, and ascertain possible facilitators and barriers to patient-centered practices in mental health settings. Design Qualitative study of six focus groups conducted in late 2013. Setting and participants Thirty-five mental health Clinicians and staff from a large VA Medical Center. Outcomes Transcripts were analyzed using an inductive and deductive thematic analysis approach. Results Participants described patient-centered care ideally as a process of shared discovery, and expressed general enthusiasm for patient-centered care. Participants described several ongoing patient-centered care practices but conveyed concerns about the practicalities of its full implementation. Participants expressed a strong desire to change the current biomedical culture and policies of the institution that may hinder Clinicians' flexibility and Clinician–Clinician collaboration when serving patients. In particular, Clinicians worried about being held responsible for addressing all of the needs or goals that a patient may identify. Conclusions If patient-centered care is to be practiced fully in mental health settings, healthcare institutions need to develop multimodal strategies to enhance Clinician–Clinician and Clinician–patient collaborations to promote and support a focus on discovery and shared accountability for outcomes.
