• Laboratory for Leveraging Evidence and Advancing Practice for Youth Mental Health Services

  • Current Projects

    Practice Based Empirically Supported Treatments (PBEST)
    Funding Source: NIMH
    Principal Investigator: Bearman
    The PBEST study is a five-year project that seeks to advance the use of empirically supported practices for youth depression in school settings. The study initially focused on characterizing the current practices used in the treatment of youth depression in public middle schools and involved a mixed-methods study with school-based treatment providers, youth who had received treatment and national experts in various theoretical orientations for youth treatment. These data informed the development of a coding manual with which 221 sessions of school-based “treatment as usual” were coded in order to determine the content and the processes of depression interventions delivered in the school context, as well as what processes and content are related to clinical improvement for youth. The next steps involve partnering with local schools and mental health practitioners within local schools to develop a treatment protocol that merges both elements of scientific evidence base and the emerging “practice-based evidence” in order to more effectively treat youth with depression. A small open trial to test the feasibility of this intervention is planned for 2013–2014.

    Measuring Adherence to Team Decisionmaking (TDM): A Pilot Study
    Funding Source: Annie E. Casey Foundation
    Principal Investigator: Bearman
    Team Decisionmaking (TDM) was developed as a way for child welfare agencies to collaboratively reach decisions regarding child removal when safety issues arise. It is intended to reduce out-of-home placements and non-kin foster care, and to engage families and community supports in the process. It is used in 17 states, but has never been directly tested in studies comparing TDM to alternative processes. In order to test the intervention, it is first essential to establish methods of measuring intervention integrity. To this end, a measure has been developed to assess that TDM is being implemented as intended. The purpose of the project is to determine whether the questionnaires completed by meeting participants provide accurate information about what happened during the meetings. For this project we have partnered with Dr. David Crampton of Case Western Reserve University (Co-Investigator) and with the Cuyahoga County Department for Children and Family Services.

    An Observational Study of Treatment Integrity: ESPs in Effectiveness Studies
    Principal Investigator: Bearman
    With increasing attention focused on the mechanisms of therapeutic improvement, two schools of thought have emerged: One group of researchers has focused on identifying and refining specific treatment strategies that are associated with improvement, whereas other researchers maintain that common factors related to the therapeutic relationship and process are more potent predictors of treatment outcome than are the specific techniques associated with particular schools of therapy. Child and adolescent therapy process research has a long history, but much of the research is descriptive, with no linkage between process and outcome. An important step toward addressing this limitation has been the development and use of observational coding systems that rely on direct observation by trained observers to produce data that are objective, and detail-specific in regards to what procedures therapists actually use in-session. This study will examine recorded sessions (both video and audio) of therapists delivering therapy to children and adolescents treated in community mental health clinics as part of treatment outcome research, and use observational coding methodology to 1) characterize the therapeutic strategies used by therapists, 2) examine the adherence and competency of therapists using ESPs in real-world settings and 3) examine the use of nonspecific therapeutic strategies in “ESP” sessions delivered in real-world settings. This study involves a partnership with Dr. John R. Weisz at Harvard University and Judge Baker Children’s Center.

    Understanding Clinician Attitudes Towards Evidence-Based Practices: A Qualitative Study
    Principal Investigator: Bearman

    Co-Investigator: Samantha Busa

    Despite an increase in the number of documented efficacious and effective empirically supported behavioral treatments (ESBTs) for youth mental health problems in the last two decades, there has not been a parallel increase in successful implementation of these ESBTs within actual practice settings. Among the key stakeholders in the dissemination and implementation of these treatments are the clinicians who provide them. Quantitative approaches to describing clinician attitudes towards ESBTs may not be well suited to capturing the subjective experiences of clinicians, and some researchers have proposed the use of qualitative data to bolster quantitative data to advance the diffusion of ESBTs. Previous qualitative studies on this topic have focused on doctoral level clinicians or community clinicians who volunteered to participate in a randomized clinical trial. Since master’s level clinicians provide the majority of mental health services for children and adolescents, it is necessary to study this unique sub-group. For this project, we are collecting qualitative and quantitative data in order to improve the breadth of information about master’s level community clinicians and their attitudes towards ESBTs. This study aims to identify perceived barriers and facilitators of master’s level clinicians towards ESBTs who have not previously been studied independently. We hope that the qualitative information may present more complex themes that will suggest potential inroads to promoting ESBTs more effectively. 

    Developing Therapist Competency
    Principal Investigator: Bearman

    Co-Investigator: : Robyn Schneiderman

    A number of mental health treatments have been tested and shown to be efficacious for children and adolescents with a variety of disorders in research-based randomized clinical trials (RCTs). Dissemination and implementation of efficacious EBPs in community mental health settings is crucial because the majority of youth who receive psychiatric services will be treated in these settings. Sadly, most youth who are treated for mental health problems will not receive treatments that have been shown to be effective, or may receive treatments that are delivered less than optimally. One possible explanation for this troubling phenomenon is that trainings in new practices do not result in the level of therapist competency required for EBPs to be maximally effective. A closer examination of the mechanisms that promote the development of EBT competency can inform future efforts to advance the use of EBPs in community settings. This study will examine the effectiveness of a training model that includes a didactic and experiential workshop plus supervision. All participants will have the unique opportunity to take part in a training on the use of cognitive restructuring for treating youth depression and will then receive three follow-up supervisory sessions and the opportunity to rehearse skills with a confederate client.  

     

     

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