ku conference talk oct 2014 handouts
TRANSCRIPT
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Michael A. Southam-Gerow, Ph.D. Virginia Commonwealth University
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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Pretreatment Posttreatment
Barrington et al. (2005) CBT Anx
Weisz et al. (2009) CBT Dep
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Pretreatment Posttreatment
Barrington et al. (2005) CBT Anx
SG et al. (2010) CBT Anx
Weisz et al. (2009) CBT Dep
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Clarke et al. (2002) CBT Dep
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Clarke et al. (2002) CBT Dep
Kerfoot et al. (2004) CBT Dep
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Clarke et al. (2002) CBT Dep
Kerfoot et al. (2004) CBT Dep
Clarke et al. (2005) CBT Dep
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Pretreatment Posttreatment
Barrington et al. (2005) CBT Anx
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Pretreatment Posttreatment
Barrington et al. (2005) CBT Anx
Barrington et al. (2005) UC Anx
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Pretreatment Posttreatment
Weisz et al. (2009) CBT Dep
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Pretreatment Posttreatment
Weisz et al. (2009) CBT Dep
Weisz et al. (2009) UC Dep
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Pretreatment Posttreatment
SG et al. (2010) CBT Anx
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Pretreatment Posttreatment
SG et al. (2010) CBT Anx
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)
Trea
tmen
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Schoenwald & Hoagwood (2001); Southam-Gerow, Rodriguez, Chorpita, & Daleiden (2012)
Child symptoms
Child/family
Schoenwald & Hoagwood (2001); Southam-Gerow, Rodriguez, Chorpita, & Daleiden (2012)
Child symptoms
Child ethnicity
Child/family
Schoenwald & Hoagwood (2001); Southam-Gerow, Rodriguez, Chorpita, & Daleiden (2012)
Child symptoms
Child ethnicity
Family income
Child/family
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Schoenwald & Hoagwood (2001); Southam-Gerow, Rodriguez, Chorpita, & Daleiden (2012)
Child symptoms
Child ethnicity
Family income
More and more!!!
Child/family
Schoenwald & Hoagwood (2001); Southam-Gerow, Rodriguez, Chorpita, & Daleiden (2012)
Child symptoms
Child ethnicity
Family income
More and more!!!
Child/family
Trea
tmen
t
Therapist
Child/family
Trea
tmen
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Schoenwald & Hoagwood (2001); Southam-Gerow, Rodriguez, Chorpita, & Daleiden (2012)
Agency/organization
Therapist
Child/family
Trea
tmen
t
Schoenwald & Hoagwood (2001); Southam-Gerow, Rodriguez, Chorpita, & Daleiden (2012)
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Systems
Agency/organization
Therapist
Child/family
Trea
tmen
t
Schoenwald & Hoagwood (2001); Southam-Gerow, Rodriguez, Chorpita, & Daleiden (2012)
¡ 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
¡ 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
¡ 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
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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
0 10 20 30 40 50 60 70 80 90
0
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0
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0 10 20 30 40 50 60 70 80 90
Practice
Progress
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
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
Primary Diagnosis: Depression Ethnicity: African American
0 10 20 30 40 50 60 70 80 90
0
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20
30
40
50
60
70
80
0
5
10
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20
25
0 10 20 30 40 50 60 70 80 90
Evidence of Improving Trend
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
0 50 100
150
200
250
300
3 months
6 weeks
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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0.5
1
1.5
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4.5
Standard Modular Usual Care
BPC Total-Youth
Weisz et al. (2012) Archives of General Psychiatry
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1
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6
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%)
Southam-Gerow et al., 2014
58%
42%
Sex Male Female
69% 8%
17% 6%
Ethnicity Hispanic White Black Other
Southam-Gerow et al., 2014
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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