The Brief Adjustment Scale-6 (BASE-6) was recently developed and initially examined as a brief, reliable, no-cost survey for measuring general psychological functioning within Measurement-Based Care (MBC). This study aims to further evaluate the psychometric properties of the BASE-6 in both clinical and nonclinical populations. More specifically, psychometric properties including reliability and validity, generalizability for different race/ethnic samples, and clinical utility within the context of MBC were examined. Three adult samples participated in this study: online community participants (Sample 1: n = 394), college students (Sample 2: n = 249), and individuals receiving outpatient clinical services (Sample 3: n = 80). Participants within the clinical sample regularly completed the BASE-6 while receiving evidence-based treatment in a community based psychological training clinic, where the practice of MBC is standard. Results showed that the BASE-6 had a high level of internal consistency and good test-retest reliability. It showed high convergent validity through a significant positive correlation with total and subscale scores of the Depression Anxiety Stress Scale-21 (DASS-21). Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) results supported a unidimensional model that strongly fit the data. All results were uniform across samples. When comparing the clinical and nonclinical samples, participants from the clinical sample demonstrated higher scores in total and most of the single items of the BASE-6. Finally, within the clinical sample, the BASE-6 was sensitive enough to capture change over time by demonstrating a large effect size of pre-post treatment changes and significant linear change in multilevel growth modeling. These results support the BASE-6 as a reliable and valid measure that has a one-factor structure, regardless of race/ethnicity and participants’ clinical status. Additionally, it can sensitively detect clinical change in individuals over the course of the treatment. Thus, the BASE-6 appears to accurately monitor overall psychological adjustment. / M.S. / The Brief Adjustment Scale-6 (BASE-6) is a short, no-cost survey that assesses general psychological adjustment. It can be used in a psychotherapy setting to evaluate overall functioning of individuals on a regular basis. This study aims to further investigate the BASE-6 in both clinical and nonclinical populations, more specifically, whether the BASE-6 questionnaire is reliable, consistent, and valid with various race/ethnic populations. Additionally, it was examined if the BASE-6 can sensitively capture the change in psychological adjustment over the course of treatment. Three adult groups participated in this study: online community participants (Sample 1: n = 394), college students (Sample 2: n = 249), and individuals receiving outpatient clinical services (Sample 3: n = 80). Participants within the clinical sample regularly completed the BASE-6 while receiving psychotherapy in a community based psychological training clinic. Results showed that the BASE-6 was a reliable, consistent measure and the items all measured the same construct – general psychological adjustment. The BASE-6 was also highly correlated with depression, anxiety, and stress. Results did not differ across samples or race/ethnicity. When comparing the clinical and nonclinical samples, participants from the clinical sample showed higher scores of the BASE-6. Finally, within the clinical sample, the BASE-6 was sensitive enough to capture change over time by demonstrating large treatment changes from the beginning until the end of the treatment. These results support the BASE-6 as a reliable and valid measure regardless of race/ethnicity and participants’ clinical status. Additionally, it can sensitively detect clinical changes in clients over the course of the treatment. Thus, the BASE-6 appears to accurately monitor overall psychological adjustment.

In routine outcome monitoring (ROM), the rate and timing of treatment failure alerts has been related to the success of feedback in past randomized clinical trials. In a recent OQ-45 feedback study, Burlingame and colleagues (2018) found that the rates and timing of not-on-track (NOT) progress alerts in group treatment were different than those reported for individual treatment. Using data from 58 different therapy groups and 374 patients, NOT progress alerts occurred at 186% of the rate reported by Shimokawa et al. (2010) when they examined over 6,000 patients receiving individual therapy at the same clinics. Another significant difference was found on the timing of the first NOT progress alerts with group treatment's first alerts occurring two sessions later than individual treatment. The goal of the current study was to use de-identified archival OQ-45 data from patients receiving group and individual treatment at a comparable clinic to determine if these rate and timing differences were replicable. Data from individual therapy (N = 5,493) and group therapy (N = 146) patients' OQ-45 scores show that the present study duplicated the significant difference found in the rate of NOT alerts between these formats. Relative risk of alerting as NOT at least once in group therapy was calculated to be 1.43 compared to individual therapy (group patients are 143% more likely to alert than individual patients). On the other hand, the present study did not find a significant difference in the timing of first alerts between formats. The implication of these results are significant when considering ROM in group therapy. Patients participating in group therapy are much more likely to flag as not-on-track later during the course of treatment when compared to patients in individual therapy.

The last 3 decades have seen a dramatic increase in the creation and effective use of spiritually integrated therapy (SIT) for a wide variety of client populations and clinical issues. The outcome research on SIT has increased and improved dramatically, yet process research on SIT has lagged somewhat. While valuable, prior process-oriented studies on SIT have used retrospective survey methods and asked about generalized usage rates of predetermined spiritual interventions. Rather than relying on retrospective reports of SIT with clients, there is great value and likely greater accuracy in examining session-by-session usage of SIT with clients and identifying correlational patterns between clinical issues and spiritual interventions. The current study used a descriptive, practice-based evidence approach and analyzed session-by-session process data from a private practice explicitly marketed as offering SIT. After every therapy session, eight therapists at this site completed an in-depth process measure, the Clinically Adaptive Therapist Session Checklist, and reported which clinical issues they discussed and which spiritual interventions they used in session. Findings revealed that therapists discussed self-esteem, anxiety, depression, and religious/spiritual concerns in over half of their sessions. Therapists also endorsed affirming clients' divine worth, encouraged trusting God, encouraged clients to listen to their heart, and encouraged accepting God's love in over half of their sessions. The strongest positive correlations between spiritual interventions and clinical issues were between challenging shame and challenging fear, and emotional orientation (r = 0.664 and 0.648, respectively). The clinical patterns found in this analysis illustrate one way of incorporating spirituality into clinical work. This study highlights the importance of routine outcome/process monitoring systems to help illuminate the process of SIT and contribute to deliberate practice efforts in the field. This study also stimulated discussion on the distinction between SIT and being a spiritually centered therapist.

Hispanic youth and families, although they comprise a sizeable portion of the population, are underrepresented in mental health settings within the United States and face significant barriers to receiving adequate treatment. Specifically, the lack of availability of Spanish assessment tools for application in treatment prohibits Hispanic clients from accessing the full extent of available therapeutic resources. The Treatment Support Measure (TSM) is a valid and reliable instrument that allows clinicians and researchers to collect information to better understand change processes and relevant client characteristics in therapy. The present study created a Spanish-translated version of the parent and youth TSM (TSM-SP) and assessed its psychometric properties in a Spanish-speaking community sample of 177 youth and 214 adult caregivers. The internal consistency reliability of all domains of the parent and youth versions of the TSM-SP was good, aside from the Youth Motivation domain. In contrast, the test-retest reliability of all domains of the parent and youth versions of the TSM-SP were generally poor. The construct validity of all domains of the parent and youth versions of the TSM-SP as examined by confirmatory factor analysis was excellent, aside from the Youth Motivation domain. Overall, these results laid the foundation for future research examining the utility and properties of the TSM-SP. The TSM-SP has potential to provide clinicians treating Spanish-speaking youth and families with a useful tool to help better serve these populations in therapy and broaden the scope of research into change processes in youth therapy to involve more diverse populations.

No description available.

The ability to monitor client change in psychotherapy over time is vital to quality assurance in psychotherapy as well as the continuing improvement of psychotherapy research. Currently there is not a free and comprehensive outcome measure for psychotherapy that meets current research and treatment goals. This study took further steps to validate a suite of measures to aid in treatment and research, theoretically based in the research domain criteria (RDoC) and the phase model of change frameworks. Items previously tested in a community sample were further tested in a clinical population in psychotherapy training clinics and a community clinical sample Data was analyzed using bi-factor confirmatory factor analysis and multidimensional item response theory. Additional exploratory analyses were conducted to explore differential item functioning in these samples.

Measurement Based Care (MBC) is considered to be an evidence-based practice. Despite its well-documented efficacy, it is underutilized in the clinical community for various reasons, including clinician and patient buy-in. A key component to the successful implementation of MBC is the routine administration of Patient Reported Outcome Measures (PROMs). There is a lack of research describing the utilization of MBC in a telehealth setting. As technological innovations continue, a greater number of clinics are offering telemental health services. Additionally, the COVID-19 pandemic caused a majority of underprepared clinics to begin implementing telehealth. The present study sought to evaluate patient compliance with PROMs in MBC after an abrupt shift to telehealth due to the COVID-19 pandemic. Participants were collected from a clinical population at a community based psychological training clinic. The participants were separated into groups: modality 1 (in-person services, n = 17), modality 2 (telehealth services, n = 17), and modality 3 (hybrid of modalities 1 and 2, n = 10), to assess the effect of modality on mean PROM compliance. The participants were separated into groups adult (≥18 years of age, n = 23) and child (<18 years of age, n = 17), to assess the effect of maturity on mean PROM compliance. Results showed that mean PROM compliance was significantly higher in the in-person modality than the telehealth modality. Results also showed that PROM compliance was significantly higher in adults than in children. There was not a significant interaction effect of modality and maturity on PROM compliance. Additionally, results showed that PROM compliance decreased significantly after the switch from in-person services to telehealth services in the hybrid modality. These findings show that clinics may face significant barriers to the implementation of MBC after a sudden shift to telehealth caused by an unforeseen stressful event. / M.S. / Measurement-Based Care (MBC) is an effective practice for the treatment of patients in psychological practices. It is a collaborative process that involves the clinician and patient tracking treatment progress and outcomes through the use of consistently administered measures known as Patient Reported Outcome Measures (PROMs). Although MBC has been shown to be effective, there is little literature regarding its use in a telehealth setting. As a greater number of clinics begin offering telehealth services, questions regarding patient adherence to interventions have arisen. Furthermore, the global COVID-19 pandemic forced a majority of underprepared clinics to offer telehealth services. The current study sought to better understand potential barriers to the implementation of MBC in a telehealth setting. Participants were collected from patients receiving therapy at a community based psychological training clinic. The participants were separated into the groups: in-person services (n = 17), telehealth services (n = 17), and hybrid of in-person and telehealth (n = 10), to assess the effect of modality on mean PROM compliance. The participants were separated into groups adult (≥18 years of age, n = 23) and child (<18 years of age, n = 17), to assess the effect of maturity on mean PROM compliance. Results showed that patients in the in-person therapy group were more likely to complete their measures than patients in the telehealth therapy group, regardless of their maturity. Additionally, adult patients were more likely to complete their measures than child patients, regardless of the modality. Results also showed that patients who experienced both in-person and telehealth services were more likely to complete their measures before the switch to telehealth. These findings show that clinics may face significant barriers to the implementation of MBC after a sudden shift to telehealth caused by an unforeseen stressful event.

In recent years, there has been an ever increasing emphasis placed on the collection and use of patient reported outcome measures (PROM) in mental health services. This emphasis stems from a culture of evidence based practice, wherein PROM are shown to improve therapeutic outcomes at the clinical level, as well as provide information for the appropriate development of services and commissioning at a national level. This study uses an online survey to explore the use of PROM by mental health staff (n=112) in various Child and Adolescent Mental Health Services across England. Attitudes toward routine outcome monitoring practices and perceived competency around PROM use were also measured. Results found that although significant numbers of staff were using PROM, the amount of data being collected falls short of policy targets. Staff’s attitudes towards the practice are shown to be ambivalent, whereas overall perceived levels of competency were reasonably good. The relationships between attitudes, competence and PROM usage are discussed and a prediction model for PROM usage is developed in light of existing psychological theory. Results showed that training played an important role in the uptake of PROM and implications for the dissemination of training programs are emphasised.

The Outcome Questionnaire (OQ-45; Lambert et al., 1996) has been widely employed as a psychotherapy outcome monitoring measure following research findings that support various aspects of its validity and sensitivity to change. Despite its broad usage in both clinical and research settings, some of its psychometric properties are not definite. The three subscales of the OQ-45 are designed to measure three distinct, but related, aspects of psychological functioning. However, neither the one- nor three-factor models have been supported by previous research. Likewise, the results of the current study supported neither of those factor structures. It was suspected that heterogeneity in data might have led to the lack of the confirmatory factor analysis model fit. Therefore, factor mixture modeling (FMM), a combination of confirmatory factor analysis and latent class analysis, was employed to investigate potential heterogeneity of the data. Among the series of factor mixture models with varying numbers of classes that were fitted, the two-class, unconditional FMM based on the revised three-factor solution was decided to best describe the data under analysis. Although three covariates of clinical status, sex, and race were selected as known sources of heterogeneity and incorporated into the FMMs (i.e., conditional model), the findings were contradictory to expectations. The implications of these findings in counseling were discussed in terms of aggregating OQ-45 scores and its score interpretation. Furthermore, this study demonstrates the process involved and dilemmas encountered in choosing the best fitting FMM. There is currently no criterion for assessing individual model fit. Instead, models’ fit are compared using various information criteria (IC). And, as was found in the current study, these ICs are frequently contradictory. Thus, the process of identifying the best fitting model cannot rest solely on fit indices but must also depend on interpretation of models and consideration of the ultimate use of the results. In the current study, consideration of transition matrices and the pattern of latent means across classes contributed as much to model selection as fit index interpretation. / text

Studies on relations between number of sessions and effect of psychotherapy have usually assumed a constant rate of change across different lengths of therapy, explained by a model called the dose-effect model. This assumption has been challenged by the good-enough level (GEL) model, which makes the prediction that the rate of change will vary as a function of total number of sessions. This study aimed to compare these models. We also assessed the relationship between reliable and clinically significant change (RCSI) and total dose of therapy. Participants were drawn from two datasets in the Swedish primary care (n = 640) and adult psychiatric care (n = 249). The participants made session-wise ratings on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). Multilevel analyses indicated a better fit using the GEL-model, with some reservations concerning RCSI and patterns of change. The results may indicate a general lawful relationship that may have implications for future research, as well as psychotherapy practice and policy making.