This systematic review evaluates the implementation of treatment integrity procedures in outcome studies of youth interventions targeting behavioral problems. The Implementation of Treatment Integrity Procedures Scale (ITIPS), developed by Perepletchikova, Treat, and Kazdin (2007), was adapted (ITIPS-A) and used to evaluate 32 outcome studies of evidence-based interventions for youths with externalizing behavioral problems. Integrity measures were found to be still rare in these studies. Of the studies that took integrity into account, 80% approached adequacy in implementing procedures for treatment integrity. The ITIPS-A is recommended as an instrument to guide development of integrity instruments and the implementation of treatment integrity procedures in youth care.
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Risk assessment instruments are widely used to predict risk of adverse outcomes, such as violence or victimization, and to allocate resources for managing these risks among individuals involved in criminal justice and forensic mental health services. For risk assessment instruments to reach their full potential, they must be implemented with fidelity. A lack of information on administration fidelity hinders transparency about the implementation quality, as well as the interpretation of negative or inconclusive findings from predictive validity studies. The present study focuses on adherence, a dimension of fidelity. Adherence denotes the extent to which the risk assessment is completed according to the instrument’s guidelines. We developed an adherence measure, tailored to the ShortTerm Assessment of Risk and Treatability: Adolescent Version (START:AV), an evidence-based risk assessment instrument for adolescents. With the START:AV Adherence Rating Scale, we explored the degree to which 11 key features of the instrument were adhered to in 306 START:AVs forms, completed by 17 different evaluators in a Dutch residential youth care facility over a two-year period. Good to excellent interrater reliability was found for all adherence items. We identified differences in adherence scores on the various START:AV features, as well as significant improvement in adherence for those who attended a START:AV refresher workshop. Outcomes of risk assessment instruments potentially impact decision-making, for example, whether a youth’s secure placement should be extended. Therefore, we recommend fidelity monitoring to ensure the risk assessment practice was delivered as intended.
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During the past decades deinstitutionalisation policies have led to a transition from inpatient towards community mental health care. Many European countries implement Assertive Community Treatment (ACT) as an alternative for inpatient care for “difficult to reach” children and adolescents with severe mental illness. ACT is a well-organized low-threshold treatment modality; patients are actively approached in their own environment, and efforts are undertaken to strengthen the patient’s motivation for treatment. The assumption is that ACT may help to avoid psychiatric hospital admissions, enhance cost-effectiveness, stimulate social participation and support, and reduce stigma. ACT has been extensively investigated in adults with severe mental illness and various reviews support its effectiveness in this patient group. However, to date there is no review available regarding the effectiveness of youth-ACT. It is unknown whether youth-ACT is as effective as it is in adults. This review aims to assess the effects of youth-ACT on severity of psychiatric symptoms, general functioning, and psychiatric hospital admissions.
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Competent delivery of interventions in child and youth social care is important, due to the direct effect on client outcomes. This is acknowledged in evidence-based interventions (EBI) when, post-training, continued support is available to ensure competent delivery of the intervention. In addition to EBI, practice-based interventions (PBI) are used in the Netherlands. The current paper discusses to what extent competent delivery of PBI can be influenced by introducing supervision for professionals. This study used a mixed-method design: (1) A small-n study consisting of six participants in a non-concurrent multiple baseline design (MBL). Professionals were asked to record conversations with clients during a baseline period (without supervision) and an intervention period (with supervision). Visual inspection, the non-overlap of all pairs (NAP), and the Combinatorial Inference Technique (CIT) scores were calculated. (2) Qualitative interviews with the six participants, two supervisors, and one lead supervisor focused on the feasibility of the supervision. Four of six professionals showed improvement in treatment fidelity or one of its sub-scales. Had all participants shown progress, this could have been interpreted as an indication that targeted support of professionals contributes to increasing treatment integrity. Interviews have shown that supervision increased the professionals’ enthusiasm, self-confidence, and awareness of working with the core components of the intervention. The study has shown that supervision can be created for PBI and that this stimulates professionals to work with the core components of the intervention. The heterogeneous findings on intervention fidelity can be the result of supervision being newly introduced.
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Background In a large randomized trial, Utrecht PROactive Frailty Intervention Trial (U‐PROFIT), we evaluated the effectiveness of an integrated program on the preservation of daily functioning in older people in primary care that consisted of a frailty identification tool and a multicomponent nurse‐led care program. Examination of treatment fidelity is critical to successful translation of evidence‐based interventions into practice. Aims To assess treatment delivery, dose and content of nursing care delivered within the nurse‐led care program, and to explore if the delivery may have influenced the trial results. Methods A mixed‐methods study was conducted. Type and dose of nursing care were collected during the trial. Shortly after the trial, a focus group with nurses was conducted to explore reasons for the observed differences between the type and dose of nursing care delivered. Results A total of 835 older persons were included in the nurse‐led care program. The mean age was 75 years, 64% were female and 53.5% were living alone. The most frequent self‐reported conditions were loneliness (60.8%) and cognitive problems (59.4%). One‐third of the patients with a geriatric condition received an additional assessment (e.g., Mini‐Mental State Examination), and the majority of these patients received at least one nurse intervention (>85%). Most nursing care was delivered to patients at risk of falling and to those with urinary incontinence. Patients with nutrition problems seldom received nursing interventions. The nurses explained that differences in type and dose were influenced by the preference of the patient, the type of geriatric problem, and the time required to apply a nurse intervention. Linking Evidence to Action All intervention components were delivered; however, differences were observed in the type and dose of nursing care delivered across geriatric conditions. The findings better explain the treatment fidelity and suggest that there is room for improvement that may result in more beneficial patient outcomes.
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Aim: To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse-coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design: A mixed-methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods: Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi-structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data-analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results: The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in-hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion: Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non-significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact: In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.
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Background: More knowledge about characteristics of children and adolescents who need intensive levels of psychiatric treatment is important to improve treatment approaches. These characteristics were investigated in those who need youth Assertive Community Treatment (youth-ACT). Method: A cross-sectional study among children/adolescents and their parents treated in either a regular outpatient clinic or a youth-ACT setting in a specialized mental health treatment center in the Netherlands. Results: Child, parent and family/social context factors were associated with treatment intensification from regular outpatient care to youth-ACT. The combination of the child, parent, and family/social context factors adds substantially to the predictive power of the model (Nagelkerke R2 increasing from 36 to 45% for the three domains separately, to 61% when all domains are combined). The strongest predictors are the severity of psychiatric disorders of the child, parental stress, and domestic violence. Conclusions: Using a wide variety of variables that are potentially associated with treatment intensification from regular outpatient clinic to youth-ACT, we constructed a regression model illustrating a relatively strong relation between the predictor variables and the outcome (Nagelkerke R2 = 0.61), with three strong predictors, i.e. severity of psychiatric disorders of the child, parental stress, and domestic violence. This emphasizes the importance of a system-oriented approach with primary attention for problem solving and stress reduction within the system, in addition to the psychiatric treatment of the child, and possibly also the parents. Auteurs: Vijverberg, R., Ferdinand, R., Beekman, A., & van Meijel B.
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Background: Phantom limb pain is a frequent and persistent problem following amputation. Achieving sustainable favorable effects on phantom limb pain requires therapeutic interventions such as mirror therapy that target maladaptive neuroplastic changes in the central nervous system. Unfortunately, patients’ adherence to unsupervised exercises is generally poor and there is a need for effective strategies such as telerehabilitation to support long-term self-management of patients with phantom limb pain. Objective: The main aim of this study was to describe the user-centered approach that guided the design and development of a telerehabilitation platform for patients with phantom limb pain. We addressed 3 research questions: (1) Which requirements are defined by patients and therapists for the content and functions of a telerehabilitation platform and how can these requirements be prioritized to develop a first prototype of the platform? (2) How can the user interface of the telerehabilitation platform be designed so as to match the predefined critical user requirements and how can this interface be translated into a medium-fidelity prototype of the platform? (3) How do patients with phantom limb pain and their treating therapists judge the usability of the medium-fidelity prototype of the telerehabilitation platform in routine care and how can the platform be redesigned based on their feedback to achieve a high-fidelity prototype?
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To prepare medical students appropriately for the management of toxicological emergencies, we have developed a simulation-based medical education (SBME) training in acute clinical toxicology. Our aim is to report on the feasibility, evaluation and lessons learned of this training. Since 2019, each year approximately 180 fifth-year medical students are invited to participate in the SBME training. The training consists of an interactive lecture and two SBME stations. For each station, a team of students had to perform the primary assessment and management of an intoxicated patient. After the training, the students completed a questionnaire about their experiences and confidence in clinical toxicology. Overall, the vast majority of students agreed that the training provided a fun, interactive and stimulating way to teach about clinical toxicology. Additionally, they felt more confident regarding their skills in this area. Our pilot study shows that SBME training was well-evaluated and feasible over a longer period.
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In psychiatric care professionals perceive some patients as 'difficult', especially patients with long-term non-psychotic disorders. For these patients few evidence-based treatments exist. An intervention program, Interpersonal Community Psychiatric Treatment (ICPT), was developed by the authors. It was evaluated with the aim to increase effective behaviours by both patients and community psychiatric nurses (CPNs).
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