KU Conference Talk Oct 2014 Handouts

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Michael A. Southam-Gerow, Ph.D. Virginia Commonwealth University

[email protected]

Source Research Funding

Paid consulting Equity

PracticeWise, LLC P NIMH P

¡  Thanks to VCU collaborators (including alum): Dr. Bryce McLeod & Dr. Scott Vrana; Cassidy Arnold, Dr. Ruth Brown, Julia Cox, Alison Eonta, Selamawit Hailu, Dr. Shannon Hourigan, Nadia Islam, Ruben Martinez, Dr. Kimberly Parker, Alexis Quinoy, Adriana Rodriguez, Katie Sanchez, Meghan Smith, Carrie Tully, Dr. Alyssa Ward, Emily Wheat

¡  Thanks to PracticeWise Leadership Team: Dr. Bruce Chorpita (UCLA), Dr. Eric Daleiden (PracticeWise, LLC)

¡  The National Institute of Mental Health: For funding support (R01-MH86529); special thanks to Dr. Joel Sherrill

¡  (One of) the problems we face: Mental health care for children/families

¡  Progress and challenges in solving that problem

¡  Ways to move forward (…and change the world)

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Pretreatment Posttreatment

Barrington et al. (2005) CBT Anx

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Weisz et al. (2009) CBT Dep

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Clarke et al. (2002) CBT Dep

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SG et al. (2010) UC Anx

STRONG start…

And we have work to do

¡  Our early focus: Stage Model

¡  Good idea + tell people= ?????

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¡  Early approach §  Basic->Early Clinical->Efficacy->Effectiveness

¡  Modification described at Delaware Project meetings §  Basic->Early Clinical->Efficacy(Lab)->Efficacy (Comm)-

>Effectiveness

Presented at the Delaware Project meeting Retrieved from http://128.175.41.92/wordpress/wp-content/uploads/2012/10/Cat-3.1-ppt-4-Onken.pdf

¡  Diffusion: planned or unplanned/spontaneous spread of an innovation

¡  Dissemination: directed and planned spread of an innovation §  Cf. Chambers et al. (2005) “targeted distribution of a well

designed set of information” (p. 323).

¡  Implementation: the processes and strategies needed to adapt the innovation to fit within a specific context. §  Cf. Fixsen et al. (2005) : “a specified set of activities designed

to put into practice an activity or program of known dimensions” (p. 5)

Southam-‐Gerow, M. A., Arnold, C. C., Tully, C. B., & Cox, J. R. (in press).

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¡  Best ways to disseminate?

¡  What factors influence successful implementation?

¡  How can we adapt the innovation?

¡  Hesitance to build something new (vs. improve current product)

¡  Confusing “adding features” with “improving product”

¡  Emphasizing features over simplicity

¡  Choosing not to collaborate

¡  Failure to understand importance of localization

¡  Researchers are not the market/audience

Sources: -Martin Cagan http://www.svpg.com/assets/Files/toppmmistakes.pdf -Manoj Juyal http://www.netsolutionsindia.com/blog/7-common-software-product-development-mistakes-to-avoid/ -Dan Maccarone http://venturebeat.com/2014/04/28/5-product-design-mistakes-you-need-to-avoid/ -Ozgur http://ozgurzan.com/2011/08/31/common-mistakes-in-new-product-development/

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Child/family

Schoenwald & Hoagwood (2001); Southam-Gerow, Rodriguez, Chorpita, & Daleiden (2012)

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Child symptoms

Child/family


Child symptoms

Child ethnicity

Child/family


Child symptoms

Child ethnicity

Family income

Child/family

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Child symptoms

Child ethnicity

Family income

More and more!!!

Child/family


Child symptoms

Child ethnicity

Family income

More and more!!!

Child/family

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Therapist

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Agency/organization

Therapist

Child/family

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Systems

Agency/organization

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¡  Using partnership research §  Cf. Collaborative design

¡  Leveraging the evidence base differently

Partnership research & treatment adaptation

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¡  Folks working together to solve “shared” problems

¡  Works best when there are §  Shared agendas §  AND §  Shared responsibilities

¡  ‘It is one thing to say with the prophet Amos, “Let justice roll down like mighty waters,” and quite another to work out the irrigation system.’

William Sloane Coffin, Social activist and clergyman

¡  Partner with stakeholders in adaptation of EBTs for use in their settings

¡  Use science to answer stakeholder questions

¡  Conduct research in community settings, involving stakeholders

Southam-Gerow, 2005

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¡  Phase 0: Prior ethnography and early single case studies

¡  Phase 1: Qualitative Interviews

¡  Phase 2: Single case studies

¡  Phase 3: Open trial

¡  Importance of community-based studies

¡  Collaborative design

¡  For which careers are we training our students?

¡  A system developed in Hawai’i in the late 1990s

¡  Leverages current and builds new evidence

¡  Has some similarities to and differences from modular and transdiagnostic approaches

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¡  Outcome Centered

¡  Information Oriented

¡  Supports a Common Language

¡  Integrates Multiple Evidence Bases

¡  Coordinates Observed and Expected Values

¡  Self-correcting

¡  Promotes Public Visibility

¡  Aids Process Management

¡  Emphasizes Collaborative Design










General Knowledge

Local Knowledge

Treatment Research

Aggregated Cases

Individual Case

Clinical Theory

What Services To Provide

Where to Provide Services

Treatment Team

Supervision

Client Progress

Service Quality










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¡  Building a Local Evidence Base to Inform Adaptation, Self-Correction

Progress and Practice Monitoring Tool Case ID: Maggie Clear All Data

Age (in years): 7.1 Gender: Female Yes Redact FileNoTo Today

Progress Measures: To Last Event Left Scale PHQ-9 Yes PHQ-9 Yes RCADS Depression T No No No Right Scale RCADS Depression T

Engagement w ith ChildEngagement w ith Caregiver

Relationship/ Rapport BuildingGoal Setting

MonitoringSelf-Monitoring

Caregiver Psychoed: AnxietyChild Psychoed: Anxiety

ExposureCognitive: Anxiety

ModelingChild Psychoed: Depression

Caregiver Psychoed: DepressionProblem Solving

Activity SelectionRelaxation

Social SkillsSkill Building

Cognitive: DepressionCaregiver Psychoed: Disruptive

PraiseAttendingRew ards

Response CostCommands/ Effective Instruction

Dif. Reinforce./ Active IgnoringTime Out

Antecedent/ Stimulus ControlCommunication Skills: Advanced

Assertiveness SkillsCommunication Skills: Early Dev

MaintenanceOtherOtherOther

Days Since First Event

Display Time:To Last Event

Display Measure:

Primary Diagnosis: Depression Ethnicity: African American

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Progress and Practice Monitoring Tool Case ID: Maggie

Age (in years): 7.1 Gender: Female

Progress Measures: Left Scale PHQ-9 Right Scale RCADS Depression T


















Primary Diagnosis: Depression Ethnicity: African American

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Evidence of Poor Engagement

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¡  Data from Boston, MA and Honolulu, HI

¡  Data from California

Weisz et al. (2012) Archives of General Psychiatry

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Weisz et al. (2012) Archives of General Psychiatry

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Standard Modular Usual Care

BPC Total-Parent

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¡  Economic problems

¡  Mental Health Services Act

¡  Transformation plan

¡  Progress (so far)

Southam-Gerow et al., 2014

MAPFFTIY IPTCFOFPCIT

PATHSAF-‐CBTMSTDTQI

Group CBTSFMDFT

LIFEBSFTUCLA TTMCBITSPEInd CBT* (for DMH DO

only)RPPGLBT MPFOCUSPEARLSDBT* (for DMH DO

only)

11,929 (22.5%)


58%

42%

Sex Male Female

69% 8%

17% 6%

Ethnicity Hispanic White Black Other


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Pre-Post Effect Size =.81 (Cohen’s d) Southam-Gerow et al., 2014

¡  Shifting research questions/foci

¡  For which careers are we training our students?

¡  Innovative training approaches §  Methods/models of training §  Evidence-based supervision/consultation

approaches

¡  Quality improvement (QI) via §  Routine outcome measurement §  Treatment integrity measurement

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Thanks for your attention Contact Information: [email protected]

Documents

KU Conference Talk Oct 2014 Handouts